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News Roundup: September 25, 2015

Telehealth can improve access to care, decrease costs

Published by Healio
Abigail Sutton
September 25, 2015

Telehealth, which eliminates much of the need for in-person appointments, has the potential to improve access to care and decrease costs associated with patient travel, according to a research letter in JAMA Surgery.

Researchers selected a group of veterans undergoing minor surgeries amenable to postoperative telehealth evaluations at three sequential visits: telephone, in-person and video.

Visits were evaluated by four domains, including general recovery, follow-up needs, wound care needs and complications.

Thirty-five veterans agreed to participate and 23 veterans completed all three visits. Patients were mostly male (96%) and white (70%) with a mean age of 58 years.

Eleven of the 23 veterans were discharged on the day of their operation.

For general recovery and follow-up needs there was 100% agreement for all types of patients.

Agreement for wound needs and complications was 96%; there was a possible infection reported during a telephone call that was not present during the in-person or video visit.

One patient had a wound infection that was detected during telephone and video visits and confirmed at the in-person visit.

There were no situations where researchers failed to detect a wound or postoperative complications by telephone or video.

A telehealth visit was preferred by 69% of veterans. Veterans who preferred a telephone visit also favored a video visit to an in-person visit, and those that favored a video visit also chose a telephone visit to an in-person one, according to researchers.

Inside One Agency’s 5-Star Home Health Rating

Published by Home Health Care News
Kourtney Liepelt
September 25, 2015

A new star rating system for home health agencies made its debut over the summer, with 2.6% of agencies under assessment securing top marks. A Brookdale home health agency in Charlotte, North Carolina is one of these select few, and Kaiser Health News recently delved into what is behind this particular agency’s high ratings.

The federal government began evaluating home health agencies this summer on the quality of patient care they provide based on a five-star scale, but only 239 agencies out of 9,000 rated nationwide earned five stars, according to a Kaiser Health News analysis. They were rated based on nine quality measures of care practices and outcomes, including managing daily activities, treating wounds and staving off unplanned hospital care.

In North Carolina, Brookdale Home Health Charlotte stood out as one of just two agencies out of more than 170 in the state to receive five stars, according to the analysis. This means Brookdale scored well above the national three-star average.

“The key is our philosophy of doing the right thing for our patients,” Shad Morgheim, division president of Brookdale Healthcare Services, tells SHN. “Delivering high-quality care is what’s driving those results.”

Specifically, Brookdale far exceeded the national averages in quickly initiating care and easing pain, according to Medicare data. The home health agency only scored significantly below the national average in improving patients’ ability to correctly take drugs by mouth, receiving a grade of 35.1% as compared to 52.7% across the country.

“These metrics as a whole show home health’s ability to improve somebody’s function and home health’s ability to prevent costly episodes that are negative for the patient, like hospitalization or like a delay in service,” Harrison Brown, of the consulting firm The Advisory Board Company, told Kaiser Health News.

Brown said the new star ratings prove beneficial for consumers as well as the agencies, but others in the industry have cited their limitations.

“The population in home health tends to be fairly aged with multiple chance illnesses, where stabilization may be the goal rather than improvement,” said Bill Dombi, of the National Association for Home Care and Hospice.

Another limitation is that the underlying data bolstering the star ratings are self-reported.

“Some home health agencies are taking this very seriously and are getting really good real-time data and doing in and collecting the data on patients that they see, and others aren’t,” said Dan Mendelson, CEO of consulting firm Avalere Health. “That’s the situation right now.”

Brookdale is one entity collecting real-time data, namely through tablets used to update patient information along the way.

The other five-star agency in North Carolina, Well Care Home Health in Wilmington, primarily serves private homes, according to Kaiser Health News. Meanwhile, Brookdale has teams set up in 22 retirement communities in the Charlotte area alone, and Morgheim says about 80% of Brookdale’s services are administered within retirement communities and 20% to the general population.

Morgheim says those affiliations have the potential to ensure consistency and quality of care, but that it isn’t the end-all be-all for Brookdale’s success.

“For the most part, those [ratings] are independent of whether a patient is seen in a Brookdale community or within the community at large,” Morgheim says.

Study Suggests Telehealth Could Be Effective for Post-Surgery Care

Published by iHealth Beat
September 25, 2015

A majority of veterans preferred telehealth post-surgery visits to in-person follow- ups, according to a study published in JAMA Surgery, Reuters reports (Seaman, Reuters, 9/23).

Study Details
For the study, researchers from the Tennessee Valley Healthcare System, Vanderbilt University and the Department of Veterans Affairs Medical Center in Nashville evaluated data collected between May 2014 and June 2014 from 23 veterans (JAMA Surgery, 9/23). The veterans each underwent a simple operation and then had three follow-up appointments in various settings.

For example:

The first follow-up appointment was conducted by telephone;
The second follow-up appointment was conducted via video; and
The third follow-up appointment was conducted during an in-person office visit.

Study Findings
The researchers found that the providers did not miss any post-operation infections during the video or telephone visits.

In addition, the study found that 69% of the participants preferred the telehealth follow-ups to in-person follow-ups. Those who favored telehealth visits tended to live farther from the hospital than those who preferred office visits, according to the study.

Lead author Michael Vella, of Vanderbilt University Medical Center, cautioned that the study was very small and noted only one subject had a post-operative infection. He also added that telehealth visits could still miss problems and that they did not study outcomes for more complicated surgeries. Vella said that more research is needed on real-world implementation of telehealth to better gauge its safety (Reuters, 9/23).