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News Roundup: August 7, 2015

Telehealth program helps patients avoid hospital

Published by NBC
By Natasha Verma
August 7, 2015

LEE COUNTY, FL - A program at Lee Memorial Health System is lowering re-hospitalization rates.

The telehealth program started with 50 patients and has since quadrupled.

Every morning, patients are asked to check vitals at home. Numbers recorded to the monitor are instantly transmitted to Lee Memorial Health System.

Back at the office, a staff of telehealth nurses monitor 400 patients a month. The system monitors blood pressure, blood sugar, oxygen levels and weight.

Nurses detect issues before they become emergencies and hospital visits, cutting healthcare costs.

"Just to get up in the morning and get readings right away, I mean you can't beat it," said Jon Blough, a heart patient.

The equipment is free for patients already participating in home health after hospital discharge.

The program plans to add 100 monitors by October. Each set is covered by Medicare.

Telephone Therapy Helps Older People In Underserved Rural Areas, Study Finds

Published by Kaiser Health News
By Lisa Gillespie
August 7, 2015

Therapy provided over the phone lowered symptoms of anxiety and depression among older adults in rural areas with a lack of mental health services, a new study shows.

The option is important, one expert said, because seniors often have increased need for treatment as they cope with the effects of disease and the emotional tolls of aging and loss.

mental health phone 570 “Almost all older adults have one chronic medical condition, and most of these have been found to be significantly associated with anxiety disorder,” Eric Lenze, a psychiatrist and professor at the Washington University School of Medicine in St. Louis, said in an interview.

The study, by researchers at Wake Forest University and published Wednesday in JAMA Psychiatry, examined 141 people over the age of 60 living in rural counties in North Carolina who were experiencing excessive and uncontrollable worry that is brought on by a condition called generalized anxiety disorder.

The participants had up to 11 phone sessions between January 2011 and October, 2013. Half of them received cognitive behavioral therapy, which focused on the recognition of anxiety symptoms, relaxation techniques, problem solving and other coping techniques. The other study participants got a less intensive phone therapy in which mental health professionals provided support for participants to discuss their feelings but offered no suggestions for coping.

The researchers found that severity of the patients’ worries declined in both groups, but the patients getting cognitive therapy had a significantly higher reduction of symptoms from generalized anxiety disorder and depressive symptoms.

Yet many seniors could face barriers getting that therapy because Medicare has stringent requirements for eligibility for these kinds of phone therapies, according to Lenze, who wrote an editorial accompanying the study. Lenze argued that phone therapy is a good alternative to drugs that are often prescribed for anxiety and depression but can make seniors sleepy and disoriented and lead to injuries.

“This demonstrates that [therapy] is just as effective as in-person psychotherapy and reimbursing for it would be a way to increase the reach of mental health care that in a concrete way would allow someone to get treatment for actual problems, not just medicating and ending up in the emergency room with a hip fracture,” Lenze said.

He said he treats some geriatric patients who drive from 100 miles away and doesn’t offer phone sessions because of the payment issue.

Medicare only pays for telehealth services done in rural areas with provider shortages; patients cannot do a phone call in their home, but must drive to a physician’s office or hospital to connect with the mental health professional at another site, he said.

“The reason it isn’t evolving is because it’s trapped in the law that isn’t evolving with modern medicine,” said Joel White, executive director of the Health IT Now Coalition, which is urging Medicare to loosen its strict limits on telemedicine.

Many states have also implemented some roadblocks for telephone therapy with laws requiring that anyone giving medical care must be licensed in the state where the patient resides. Reps. Frank Pallone, D-N.J., and Devin Nunes, R-Calif., offered a bill in July that would allow providers licensed in one state to provide care in another state electronically.

The Association of State and Provincial Psychology Boards is working on model legislation to recommend to states next year that would allow psychologists to practice by phone across state lines without having to pay a hefty licensing fee.

Why Shifting Health Policies Favor Home Care

Published by Home Health Care News
By Cassandra Dowell
August 7, 2015

As the health care market continues to evolve, it behooves acute and post-acute care providers to evaluate strategies that align with new federal regulations, particularly those related to what’s known as population health. And this is making for a bright future for home care, industry leaders say.

Currently, 12 million people receive community-based care from home health services and hospice providers to help with post-acute and chronic conditions, disabilities, or terminal illnesses, according to a new report by Chicago, Ill.-based investment banking firm Cain Brothers.

“As more and more older people prefer to age in place and elect to live independent, non-institutionalized lives, they are choosing to receive home care services as their physical capabilities diminish,” Cain Brothers said. “Since chronically ill individuals account for about 75% of all hospitalizations, medical and technological advances will create growth opportunities for home health providers. Coupled with its relative low cost compared to other [post-acute care] PAC options, home health will see an influx of new patients in the coming years.”

The Centers for Medicare & Medicaid Services (CMS) has made clear that population health is one of its many quality initiatives as part of its overall goal to reduce health care costs. While there is some debate as to what population health management means, one top leader has her own definition and ideas about why it’s a positive for home-based care.

“Population health management [PHM] is basically the oversight involved when working with physicians, nurses, pharmacists and family members engaged in care,” said Molly Forest, CEO & president of nonprofit Los Angeles Jewish Home, regarding what PHM means in the senior care market. Forest spoke during Cain Brothers’ Population Health Management & Senior Care Market House Call on Thursday.

“Payment systems previously rewarded more acute settings for care,” Forest said. “When we see seniors today, the home is the focus. We’re seeing increased life spans and complexity of care. Sixteen percent of Baby Boomers do not have children, and that impacts the whole continuum of care. We are frequently dealing with more and more people who need care the most but have the least caregiving structure available to them.”

Los Angeles Jewish Home serves more than 4,300 senior annually through community-based, in-home, and residential services, according to the organization’s website.

“PAC providers will need to address how and where senior care is being delivered, who makes decisions on a care plan and how they are made, who bears risk in a care coordination network and the role of technology and big data in assessing outcomes,” said Cain Brothers in the report.

It’s no secret that CMS is calling the shots, and it’s up to providers to have the foresight to get ahead of impending regulations before it is too late.

“The federal government is moving with a sense of urgency to implement population health management,” said Wayne Sensor, CEO of Ensocare, a Omaha, Neb.-based company that improves discharge efficiency and care coordination, and helps reduce avoidable readmissions and operational costs. Sensor referenced Medicare’s recently proposed model that would give hospitals more financial incentives to work with PACs for patients who undergo hip and knee replacements.

Prior to President Obama’s election, some large health organizations balked at preparing for the regulatory changes that are now underway, Forest said.

“Years ago we could not get some of the major hospitals to talk to us about readmission rates because they did not believe Obama would be elected,” Forest said. “So, we started an internal study since no managed care [organization] would take us to find out why we were sending people to the hospital and how we could bring that number down.”

Today, many hospitals and health systems own or are in partnerships with home health care agencies, according to the Cain Brothers report.

“Partnering with a quality, stable provider is key to achieving consistent outcomes and ultimately, cost savings,” Cain Brothers said.