Get Full Medicare Reimbursement in the Skilled Nursing Facility

skilled nursing facility

Every skilled nursing facility must abide by rules set by Medicare, particularly when it comes to Potentially Avoidable Hospitalizations, or PAHs. In fact, Medicare will soon be changing its reimbursement policy so that if a patient is readmitted to a hospital after a short stay in skilled nursing, the facility is penalized with less reimbursement money through the Medicare program. These changes don’t go into effect until 2019, but skilled nursing facilities are already receiving feedback reports on their performance. More and more, the skilled nursing facility is discovering that telemedicine provides a viable solution for monitoring, assessing, evaluating, and diagnosing patients on site without transferring them out of the facility for care – thus avoiding getting dinged by Medicare in the process.

Telemedicine a Solution in Medicare Readmissions Reduction Program

The Centers for Medicare & Medicaid Services began its Readmissions Reduction Program under the Affordable Care Act. Under the program, if a patient is readmitted to a hospital within 30 days of discharge, then the facility sees an impact on its Medicare claims by way of reduced Medicare reimbursements. The purpose of the program is to improve the outcomes of patients residing in skilled nursing facilities by achieving a low return-to-hospital rate. Lack of after-hours and weekend staffing plays a big part in readmissions, but telemedicine is helping to close the gap in care that is prevalent throughout the industry.

Telemedicine for the Skilled Nursing Facility

From Medicare’s viewpoint, PAHs not only cost the government money, but they also result in exposure of already vulnerable nursing home patients to outside health risks and frustration. Most patient readmissions occur when there is no physician on call, often leaving support staff with little choice but to transport patients out of the facility for treatment for acute illnesses and other conditions.

With two-way video conferencing between a telehealth provider and the patient and staff, readmissions and hospitalizations can be minimized. This type of consultation allows the telehealth doctor to communicate directly with the patient, face to face, assessing the patient’s condition, making a diagnosis, and ordering the proper treatment. This saves the nursing facility from the penalty of a readmission while allowing the patient to remain in place without the hassle of being transported to an ER or clinic.

Using telemedicine, staff can work with the consulting physician via a telemedicine cart, which includes a high-quality web cam that can zoom in on specific areas of the patient’s body if needed to make a definitive diagnosis remotely without the doctor being present at the facility. From evaluating pressure wounds to determining the source of a mysterious rash, doctors using this equipment provide high-quality assessments as if they were doing their rounds in person.

Telemedicine Benefits for Skilled Nursing Facility Patients

Patients stand to reap several benefits from telemedicine in a skilled nursing facility. Patients:

  • Do not have to leave the facility needlessly and be inconvenienced with unwarranted trips to the ER.
  • Experience fewer readmissions.
  • Avoid outside health risks.
  • Can seek evaluation quickly when a condition arises.
  • May be evaluated by a physician with whom they are familiar and that they trust.
  • Can be seen 24 hours a day, every day of the year, from the comfort of their own rooms in the facility.

Implementing Telemedicine in Skilled Nursing Facilities

While not designed to replace the face-to-face healthcare that skilled-nursing patients require, telemedicine does fill a huge void left by understaffed facilities where the employment of a round-the-clock physician is not feasible.

With the October 2016 risk-adjusted PAH rates in effect, skilled nursing facilities have begun migrating to pay-for-performance. Since Medicare reimbursement for skilled nursing facilities is now based partially on each facility’s rate of readmission, telemedicine is becoming more and more vital for all facilities looking to leverage technology to not only improve patient outcomes, but reduce penalties that affect their overall bottom line.