1. Telehealth: Pursuing, Planning and Prospering Joyce Doughty, BSN, PHN, RN Director Good Samaritan Home Health Care

2. Objectives Will be able to name two groups of individuals needed to buy-in to telehealth for its successful implementation. Will be able to identify two lessons learned in telehealth start up. Will be able to identify one process improvement method.

3. About Good Samaritan Home Health Care Rural area in Southwest Minnesota Medicare certified home care provider RN, HHA, OT, PT, ST, homemakers, companions Serve 7 counties Average client load, 80-100

4. How to Get Started With a Telehealth Program We started our telehealth program in 2001 with a grant from the Bush Foundation to provide Assisted Living like services to people in their own homes. The program has expanding to four additional home care agencies with assistance from a USDA grant.

5. How to Get Started… There are grants available to help with start up costs but you need to look for them. Many foundations will fund new and innovative ways for providing health care services. Most equipment companies have rental contracts available to help with start up.

6. How to Get Started… Need staff and physician buy-in. Staff concerns: -All onsite visits replaced with telehealth visits and they will not have a job. -Use of the equipment. Most of our nurses did not learn how to run a computer in college.

7. How to Get Started… -Clients will not agree to telehealth visits because they are too impersonal. -Clients will not be able to use the equipment. -No continuity of care. The primary nurse would not know what is happening with their clients.

8. How to Get Started… Taught all staff how to run equipment and the basics for installing equipment in client homes. If left up to everyone no one does it. Appointed one nurse to be the telehealth nurse. This nurse needs to really embrace telehealth. She is the point of contact with all referrals.

9. How to Get Started … We talk about telehealth at our weekly staffing meetings. Primarily one or two nurses do the telehealth visit. Nurse and clients become familiar with each other. All the nurses do telehealth visits at least monthly.

10. How to Get Started… Physician concerns: -Dont know much about telehealth and what a visit involves. -Can confuse telehealth with telemedicine. -Patients and their families will not want telehealth visits.

11. How to Get Started… When we think a client can benefit from telehealth we call their physician and explain to them what telehealth includes. We explain how it can benefit them with decreased readmits to the hospital and decrease phone calls from families.

12. How to Get Started… We visit physicians to demonstrate our equipment and answer questions. We offer to provide them with a user name and password for accessing the secure website where the data on their patients is keep.

13. Lessons We Bring To The Table: Getting it Right! You need to be committed to telehealth to make it work for you. A telehealth program does not just happen overnight. You need to know what it is you are trying to accomplish and start with that in mind.

14. Lesson We Bring… Families really like the idea of telehealth but our clients where initially afraid of it. We often heard, I dont know how to run a computer. We would encourage them to try it for few weeks. Clients adjusted very quickly.

15. Lessons We Bring... Can teach almost anyone to use the equipment. One size does not fit all. Need to choose the appropriate technology for the client. We learned what not to say to clients as we introduce telehealth to them.

16. Lessons We Bring… We found that telehealth really does help keep clients from having frequent ER visits and readmits to hospitals. We allow our clients to call us when they are not feeling well. We will then do a connect with them. Clients do start taking control of their health.

17. Lessons We Bring… We can do 5-6 telehealth visit for each in home visits. This allows us to provide services to additional clients without additional staff. We cut down on drive time and mileage costs allowing us to have a positive bottom line.

18. Lessons We Bring Medicare allows us to use telehealth in an episode of care but they do not count toward our five visits needed to get a full episode payment. (Legislation introduced by Rep. Ramstad). In Minnesota Medical Assistance will pay for telehealth skilled nurse visit.

19. Lessons We Bring… We have worked with counties to contract to pay for nonskilled visits for medication reminders. Have begun conversations with MN Department of Human Services to allow nonskilled visits and monitoring unit services to be part of their reimbursable service menu.

20. Lessons We Bring… If we feel the client can benefit from telehealth we contact their insurance provider. Some insurance providers will pay for telehealth visits. We have developed a private pay program for individuals or families who would like telehealth services that are paid for by other payors.

21. Lessons We Bring… The small numbers in our project made it difficult to get results that payors will look at. The system to pay for telehealth visits has not been in place, but it is coming.

22. Where Do We Go From Here: Process Improvement Outcomes need to be addressed at the start of the program. From 2001-2003 we looked at five clients in retrospect. We found that we kept them out of a higher level of care for 24 months.

23. Where Do We Go…… We our combining the numbers of four home care agencies to get statistically significant results to bring to payors. Telehealth providers need to combine outcomes to get the numbers that are needed to take to payors. When we have the numbers the payors will respond.

24. Where Do We Go… As more home care providers begin asking for reimbursement payors will have to address this. As people and physicians hear about our telehealth program we get referrals for telehealth.

25. Where Do We Go… Telehealth gives us as edge over home care agencies that do not have telehealth. We have to make telehealth part of our standard of care.

26. Where Do We Go… As Medicare begins to look at telehealth in home care they will expect it to be part of what we provide. In the future there will be monetary incentives to use telehealth. As telehealth gains momentum it will become expected as part of our standards of care.

27. Contact Information Joyce Doughty jdought1@good-sam.com