August 8, 2014 | Hospitals
Although it’s clear that many hospitalizations are necessary and beneficial, residents of skilled nursing facilities experience “Potentially Avoidable Hospitalizations” (PAHs) at alarming rates. According to a recent report by Steven M. Handler, MD, PhD, CMD, such “hospitalizations are expensive, disruptive and disorienting, and nursing facility residents are vulnerable to the risks that accompany hospital stays and transitions between nursing facilities and hospitals.”
What Is a PAH and Why Is It So Common?
Moreover, the reasons behind these hospitalizations tend to be caused by a relative handful of underlying issues. Dr. Handler’s report notes that five conditions are responsible for four in five PAHs: urinary tract infections, dehydration, pneumonia, COPD/asthma and congestive heart failure.
Other conditions that contribute to PAHs include:
- Falls and trauma
- Skin ulcers
- Acute renal failure
- Poor blood sugar control
PAHs occur for a variety of reasons, including:
- Lack of advance care planning
- Poor coordination between SNF faculty and acute care facility staff
- A general physician preference toward hospitalization
- Liability issues and concerns
- Inadequate clinical training or capacity at SNFs
Preventing PAHs in Western Pennsylvania
The good news is that many PAHs are avoidable. According to research by the Centers for Medicare and Medicaid, up to 45 percent of all PAHs could be avoided. Since many skilled nursing facility residents receive coverage under Medicare and Medicaid, the potential savings for prevented hospitalizations is huge: In 2011 PAHs cost Medicare and Medicaid up to $8 billion.
At the University of Pittsburgh Medical Center (UPMC) system, the RAVEN (Reduce Avoidable Hospitalizations using Evidence-based Interventions for Nursing Facilities) initiative is leveraging the power of telemedicine to meet four core objectives:
- Reduce the frequency of avoidable hospital admissions and readmissions among skilled nursing facility residents;
- Improve health outcomes among residents;
- Improve transitional care between hospitals and nursing facilities;
- Reduce overall health spending without limiting care or reducing patient choice.
RAVEN’s leaders determined that the UPMC network needed a telemedicine system that could fill a number of important functions. First, it must leverage user-friendly software that could run on a typical browser. It must be capable of evaluating residents at any skilled nursing facility location within the network. It must also permit physicians and other staff to visually evaluate residents’ outward condition, skin and wounds. Further, it must allow staff to perform checks of basic vital signs, including heart, lung and bowel auscultations. If necessary, the technology should facilitate 12-lead EKGs, arterial and venous pulse detection and ear inspection. Notably, RAVEN’s sought telemedicine equipment that facilitated smooth consultations between patients and staff members at hospitals and nursing facilities alike
Looking Ahead: Using Telemedicine to Reduce Costs and Improve Care
According to Dr. Handler’s report, the telemedicine video conferencing systems have a variety of potential uses. For instance, a nursing home nurse who notices that a patient has developed a potential skin irritation but can’t adequately explain the situation by phone can set up a live conference that permits a hospital physician to evaluate her visually. Over the longer term, the report anticipates using the telemedicine device to facilitate direct consultations between hospital physicians and skilled nursing facility-based nurse practitioners who can manage acute changes in patients’ conditions without shipping them out to a hospital.
Although these systems can’t prevent every hospitalization, they can reduce the incidence of PAHs and ensure that patients receive excellent care in the nurturing environment of a skilled nursing facility. With nursing home residents receiving basic acute care without shipping out and hospitals free to use their resources for patients who require intensive care, this could save billions of dollars for Medicare and Medicaid while dramatically improving outcomes for those affected.