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CW Ep. 8: Healthcare & Policy with Meredith Mills

Meredith Mills, COO of Country Meadows Retirement Communities, discusses the silver lining to the Coronavirus pandemic in that telehealth has advanced at lightening speed. The need to provide care outside of senior living’s typical acute and emergency setting has made the industry think differently about solutions.

Welcome back to Bridge the Gap Contributor Wednesday, I’m Meredith Mills, Senior Vice President and Chief Operating Officer of Country Meadows Retirement Communities. It’s great to be back here once again with all of you to talk about the sexy world of healthcare policy in America. And before I begin, I hope you’ve been tuning into the other contributors who have been speaking on Bridge the Gap on Wednesdays throughout the month. And I particularly enjoyed Charles Turner’s most recent episode where he talked about the granny shot and he asked us to all share our awkward granny shot moments in life. And I would have to share that filming this podcast has been one of those moments for me. It’s certainly out of my comfort zone and a little bit awkward, but I hope that geeking out on healthcare policy has been as much fun for you as it’s been for me. And that you walk away with something new that you didn’t know before about our healthcare system, how senior living fits into that, and how you might be able to better provide resources and connections for your residents.

So I was originally going to speak today about the three hour presentation that I gave to a group of first-year medical students. That was quite an adventure. Around how the Medicare system affects all providers regardless of whether you want to be a geriatrician or treat older adults. But I’m going to hold off on that until next week, because one of the hotter topics that I really wanted to speak about is the advances in telehealth that have just moved at an astronomical speed because of the Coronavirus and the need to provide care outside of our typical acute and emergency setting. So I find it very interesting that over the past decade, we’ve been unable to figure out how to provide tele-health appropriately to older adults or anybody in the US, because we have everything available to us technologically in order to provide these services.

However, the big question mark was reimbursement. At the beginning of the pandemic, one thing that our government did that was very helpful was loosened the red tape and restrictions around tele-health provision in the US and this allowed more providers to stay in business and stay in contact with their patients outside of any type of emergency setting. I know that for our industry, even though essential healthcare providers were still allowed within our doors after visitation was closed off, there was a lot of concern around how many other communities with fragile and vulnerable older adults, these providers were also entering, and therefore, how many chances did they have to spread the virus? So immediately as a company, we really started to work with our, even our primary care providers, but also our hospice, home health and wound physicians in saying, how many can you shift over to telehealth that you previously did in person now that the rules have changed?

And some providers pivoted quickly, and other providers were really challenged with this notion. From my perspective, if you can do tele-health, why wouldn’t you do tele-health in a pandemic when you have to use additional PPE to come into separate communities, or you are even slightly chancing an older adult being more exposed to this virus because you’re moving from person to person? So from my perspective, it was very interesting to watch other healthcare providers who had trouble switching to the tele-health setting. There was so much change going on for all of us at first that I was really grateful for our familiarity with telehealth, because my company has been doing this for our residents for the past three years. And we’ve only been lucky enough to master it because we have a group of physicians that really embraced one of the newer concepts released by Medicare in 2015, which was the comprehensive care management billing codes that allow providers to charge for the time that their team spends coordinating and supporting seniors with more than two chronic conditions.

So this was one of the innovations that Medicare put out, trying to push providers to think creatively about how to better manage people at the lower cost level. And the great thing about it is that, although it requires that a patient have two or more chronic disease conditions, diseases like arthritis and high blood pressure count. So I’m sure you can imagine that 90 plus percent of your residents qualify for this type of care. So while Medicare has put out these continuous carrots for providers to be thoughtful about the coordination of care for older adults, with multiple chronic diseases, only a few providers have really been nimble enough to be able to pivot in a different direction and provide thoughtful care to support seniors. And we’ve been lucky enough to partner with some who are thinking differently. So rather than providers viewing liaising with specialists about a patient’s care as being a waste of time or communicating with their POA as lost minutes in their day, as we sometimes wish we had reimbursement for, or even educating the patient on their conditions as a non-reimbursable action, this set of billing codes, flip that on its head and instead rewards physicians for doing the right things that lead to better health outcomes for adults with multiple needs conditions.

I’ve seen these billing codes and this way of practicing really lead to a better experience for the patient as well. So for example, we had a resident who unfortunately developed a really serious eye infection that could have blinded her. She would have normally been sent to the room via ambulance, waited hours, been without an advocate and seen by an ophthalmologist brought in specifically for her care. But instead we were able to do a telehealth visit and our physicians determined that the issue could be called in to a nearby ophthalmology specialist. They negotiated with that doctor, got our resident an appointment in the next hour. And she was back to us in two hours with the proper medications to treat her condition.

This not only allowed her to avoid an hours long or deal in the emergency room, but it saved that ophthalmologist time because he was actually the one who’s often called into the hospital for these issues. So what if we had a healthcare system that not only provided better outcomes for the patient, but the provider as well. Medicare has clearly been using its innovation center to get us incrementally closer to this ideal world, but the coronavirus pandemic has ripped all the red tape off of our healthcare system and exposed it for all of its challenges and weaknesses. The pandemic has fast-tracked many of these solutions to our older adults that we could have had years ago with the technology but just didn’t have because of the regulatory environment. And so if there’s ever a silver lining to this virus pandemic, it’s the fact that it’s now making us think differently about the exposure of our residents to the acute care setting in the emergency room setting, where they could potentially be exposed to many bacteria and viruses, but now to an even more challenging and lethal virus, and many of our residents want to further avoid the emergency room setting because they know that if they’ve returned, they’ll face an even stricter isolation protocol for two weeks, where they have extremely limited social ability and exposure to any visitors. This all makes a visit to the emergency room less than ideal, in any sense.

Additionally, I know that we are all very respectful of the rules of patient choice, but those guidelines make it extremely complicated to perform the blanket. COVID testing that most of us are being asked to do by our States. At least once, if not ongoing, this becomes such a logistical nightmare, because if we’re going with the rules of a pre-COVID world, we would have to reach out to each of the primary care physicians for both our residents and our co-workers for an order to test, making a lot of additional work for our teams. However, because of the temporary changes to telehealth that were released during the pandemic, opportunities are opened for us to streamline not only the chronic disease care of our residents, but also care coordination and virus surveillance for our coworkers, the benefits of the changes made to Medicare telehealth truly cannot be minimized, not only are our residents able to avoid the risk of a physical setting that may leave them more vulnerable to contracting COVID, but it also allows us to triage care appropriately and make sure that those who don’t need to be seen in an emergency setting can be seen right in our setting at their home.

Telehealth also allows additional opportunities for really great care coordination for those with chronic diseases. And very importantly, with the vast shortage of PPE available to healthcare workers, it avoids the use of PPE, not only for visits within our communities, but also by EMTs, who might be transporting our residents to care settings other than our own. So for those of you are skeptical that older adults who live outside of our communities would even be comfortable with technology to embrace telehealth, I offer to you recent data that shows that the number of Medicare beneficiaries using telehealth services increased more than 11,000% in just over a month during this pandemic. Wow. That speaks volumes. Not only for the demand, for an interest in telehealth services, even by our oldest sector of the population, but also for the fact that this pandemic could really be pushing care down to the lowest cost setting and forcing changes that were meant to happen incrementally over time. This data and these numbers have not gone unnoticed.

And a group of 30 US senators is now pushing for telehealth expansion laws that were originally made under the emergency declaration during the pandemic to be made permanent for all Medicare beneficiaries going forward. So as somebody who loves to advocate for our older adults at both the state and national level, I encourage you to speak to your US congressmen and women about supporting these changes. So they become permanent. In a country where access to healthcare, both in rural areas and in lower income communities and for our older adults is so limited, patients of all ages could have better options for healthcare delivery if telehealth were truly embraced. And lastly, I encourage you to leverage all the benefits of telehealth, from finally connecting your residents with mental health providers who accept Medicare, which we all know are so hard to find, to leveraging the telehealth resource to establish physician oversight and ordering capability for your residents and coworkers, so that you can pave the way to an easier ongoing testing protocol for coronavirus monitoring in your community. I hope we can all not only embrace and leverage these opportunities that have been made available to us through the emergency declaration, but I hope we can also advocate that they become a permanent way of life and provision of healthcare in our country so that everyone can have access to the best possible care. And most especially our older adults can have that access.

Thanks so much for listening to this week’s Bridge the Gap Contributor Wednesday, I’m Meredith Mills, and I hope you connect with me at btgvoice.com and #bridgethegap. I’ll see you next month.

 

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  1. Mandi Block

    July 16, 2020

    This was a great segment, thank you. Dealing with COVID on campuses has illuminated the need and necessity to use technology in social engagement and health. I am still reeling about the stat: the use of telehealth has increased 11,000% during this pandemic. That underscores (and then some) we must continue to think outside the box during this pandemic. Thank you for sharing.

CW Ep. 8: Healthcare & Policy with Meredith Mills