Regional home-care agencies count on telehealth
From the Long Island Business News, December 28, 2007
By Alison Snyder

Is there a doctor in the house?

A growing number of Long Island home health-care agencies use telehealth, caring for patients through the Internet via in-home medical equipment. They say the concept results in healthier patients, lower hospitalization rates and higher patient satisfaction - and hopefully, healthier bottom lines.

However, private insurers and the government don't freely reimburse for telehealth. Agencies hope that will soon change.

In a telehealth visit, a patient checks in through an in-home monitoring system - a specialized computer with video and voice capabilities. Other attached devices check blood pressure, weight, blood oxygen and glucose levels, and a stethoscope listens to breathing or a heartbeat.

At the agency's office, a registered nurse speaks with the patient on a regular basis (anywhere from three times a week to daily), checking vitals as in a regular office visit. The checkup supplements a weekly visit and can be scheduled or unscheduled.

Home health agencies haven't always embraced telehealth.

"It's pretty overwhelming for an organization to embrace this kind of technology, because they think it's kind of counterintuitive to providing hands-on services," said Alexis Silver, senior director of policy and development at the Home Care Association of New York State.

Silver said there were only a handful of providers offering telehealth in 2002 -but little by little, interest grew.

In 2006 and 2007 a total of $7 million in government grants for home health-care providers created a buzz in the industry, as organizations speculated on the potential benefits of telehealth, setting out to measure its effectiveness, both in quality and cost.

The equipment has reduced hospitalization rates, said Carol Kolar, chief operating officer at Oakdale-based South Shore Home Services. South Shore received a $120,000 grant from the first round of funding, using it to start a telehealth program for 20 of its long-term patients who were frequently hospitalized.

Over the past two years, South Shore has seen a five percent decrease in the agency's 9.7 percent hospitalization rate in its telehealth patients.

Satisfaction rates are up among doctors and patients as well, said Deborah Hyvniak, a telehealth registered nurse at Brookhaven Hospital Medical Center's Home Health Agency, at 95 percent with patients and 100 percent with doctors. Brookhaven has seen a 10 percent decrease in hospitalization rates since implementing the program, Hyvniak said.

That's because she checks the vital signs patients put into their system each day and monitors the overall trends. For example, if she noticed a creeping increase in blood pressure, she would be able to speak with the patient about what prompted the change, and come up with a solution to treat it.

For agencies, the service saves the expense of sending a nurse three times a week for several weeks, said Karen O'Kane, vice president for continuing care services at Brookhaven's home health agency. Telehealth improves the quality of life, she added, because agencies end up connecting with a patient more frequently.

The benefit for private insurers and the government is obvious, Silver added, with fewer visits to the doctor, fewer hospitalizations and therefore fewer reimbursements.

Agencies are scrambling to fund telehealth programs long-term, and many hope Medicaid will begin to reimburse.

That milestone isn't far off - Silver said providers will be able to bill back to Oct. 1 once Medicaid has set up preliminary rates and billing codes, though no time frames have been established yet.

If reimbursements don't come soon, Kolar said, South Shore will have to drop its telehealth program - the profit margin is not that significant.

A growing number of managed care companies are making contracts for telehealth with providers, Silver said.

As for Medicare, telehealth reimbursement is more distant, Silver said, though she hopes that eventually, Medicare will get with the program.