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Raising Tech 7

Telehealth, telemedicine, virtual care, eConsult, store-and-forward….are all new terms that have been introduced to the senior living industry recently and providers can quickly find themselves feeling overwhelmed by the various approaches and applications to meet their residents, teams and health care provider unique needs. However, the introduction of telehealth has been a game-changer in clinical care delivery for those who have adopted it and the use of telehealth is only growing in the future. 

In this episode, Amber Bardon is joined by Josh Hofmeyer, Vice President and General Manager – Senior Care Services with Avel eCare and David Darr, National Director of Sales and Client Relations of Avel eCare to unpack all things telehealth. Josh and David breakdown of all the terminology around telehealth, best use of applications based on care setting and best practices for selecting partnerships and implementation. Learn guiding principles and tactical steps you can use to implement a telehealth program in your community today. 

Connect with Josh Hofmeyer and David Darr.

Welcome to Raising Tech, the podcast dedicated to transforming technology culture in senior living. I’m your host, Amber Bardon. Today we’re discussing a hot topic that has really come into focus with the COVID pandemic; telehealth. We have with us, Dave Darr and Josh Hofmeyer from Avel eCare. David and Josh welcome, and thank you so much for being here. Would you like to do a brief introduction of yourselves?

David Darr (00:42):
Sure. Thanks, Amber. We’re really happy to be part of your podcast and we appreciate the efforts Raising Tech podcast is doing to help promote and help educate the, your listeners. So my name is Dave Darr. I’m the national director of sales and client relations for Avel eCare. I’ve been in the hospital and healthcare industry for about 20 years. The last 15 I’ve dedicated to our senior population, both in the hospice world and in telehealth. I’ve been with Avel now for just under six years and have really enjoyed reaching out to the communities throughout the United States to help bring healthcare directly to their residents.

Josh Hofmeyer (01:23)
Thanks Dave. Thanks Amber. I’m Josh Hoffmeyer. I’m the senior care officer for Avel eCare, and I’ve been here for about seven years now helping to provide telehealth services to seniors in a variety of settings that we partner with. Prior to coming here, I spent several years out in the field as a licensed nursing home administrator and health services executive helping to manage skilled nursing facilities, assisted living, independent living, home health and hospice. And so I truly have a passion for seniors and making sure that they have the quality of care that they need and certainly deserve, but then also helping to support all of the clinicians and local caregivers who are taking care of those seniors at the same time.

Amber (02:13):
Telehealth is such an interesting topic because it’s been around for a while, but it hasn’t really gained a lot of traction or there hasn’t been a huge widespread use of telehealth up until COVID hit, which obviously really accelerated the adoption of telehealth. With this being somewhat of a more newly in use field with the pandemic, to start with, could you share some terms and a little bit of an overview of what telehealth is in the marketplace today?

Dave Darr (02:44):
Certainly. Telehealth is a very broad term and it’s used sometimes interchangeably with telemedicine as well, and so you can hear both of those or virtual care. It can really be a true wide variety of things. Anything from a phone call between a clinician and a patient on the other end, to sometimes they do things via text messages or emails, and as robust as a video system that has peripherals such as a stethoscope or otoscope that allows the clinician to truly dial in and see what’s going on. There’s also aspects of remote patient monitoring technology and different data perspectives and systems and softwares that you can look at and work with to really get in there and telehealth or telemedicine, whatever term you want to use to provide that patient care. And with COVID you’re right. Things certainly have been growing and expanding. And so things have become a little bit more sophisticated lately. There’s more companies diving into this type of work there there’s more physicians diving into this. And patients and their families are becoming more comfortable with it as well, which allows for this to truly keep growing into the potential that it could have.

Amber (04:12):
Could you give us a little bit more of a deep dive into some of the specific terms such as, such as, is there a difference between telehealth and telemedicine, virtual care E consult, Store and Forward? Could you describe a little bit more detail around some of those concepts for our listeners?

Josh Hofmeyer (04:29):
Absolutely. So telehealth typically is more of that potential like text messaging back and forth, or it might be emails. It’s a back and forth to really see what what’s going on with the health person, of people monitoring what’s going on. Remote patient monitoring would fall under that category as well. Telemedicine is the practice of actually providing medical services through some type of technology. And so that’s where you get the direct interactions of provider to patient in things along those lines. Virtual care is very similar to that. Making sure that you’re providing care to your patient virtually. Store and Forward is a phrase used for taking a episode of care that might be going on. The best example to probably use would be a skin condition or a wound concern where the patient can take pictures of it, upload them into a software platform, send those to their provider, and then their provider, at some point in the near future, after receiving those, can take a look at them when they have their time. So it’s not an immediate interaction between the patient and provider and that’s where that name ‘store and forward’ comes from. And then that provider takes a look at that can figure out what they want to do and gets back to the patient on what the next terms might be. There’s a lot of terminology out there I would say when it comes to this type of care. Especially as it grows and expands, that terminology just continues to get added to. And so the list keeps growing and growing.

Amber (06:10):
I’m really curious to hear your observations of the trends in the increased use of telehealth, where have you seen this really take off and grow in the senior living industry? And what do you think is driving that adoption?

Dave Darr (06:26):
Great question. Yes. The last 18 months with COVID has definitely helped boost and identify telehealth as as a solution to supporting our local communities, especially our elderly population. So it’s really in the spotlight right now. We’ve seen over the last year additional telehealth platforms coming onto the market, greater adaptation from the traditional brick and mortar hospital organizations, clinics, and primary care physicians. So they’re all doing some type of telehealth right now, and that’s really been spurred on since the pandemic began. As far as the communities that are involved you know, skilled nursing facilities were kind of always at the forefront of it. Assisted living, memory cares are really taking the forefront of telehealth along with home health and hospice situations. But what it comes down to, prior to the pandemic telehealth was really geared towards those rural communities where they didn’t have access to care where you could kind of zoom in and take care of those residents without having them travel a distance. Telehealth today is just as prevalent in the urban areas. So access to care doesn’t matter where you live, whether you’re in the big city or in the country, access to care is out there and providing the support to the staff and getting those quality outcomes is what it’s all about. So what’s boiled down to in the last year, Amber is that if, no matter where you’re at in the United States, if you want telehealth, you have the ability to get it in your community.

Amber (07:59):
That’s really great insight. What have you seen helps a community get set up for success in using telehealth?

David (08:08):
Yep. Another great question. So it’s really about having a plan, setting up a timeline for what you need. Telehealth, isn’t something you go to the store and you buy and you take out the box and you roll it out in your community. You really have to have that timeline. In some buildings, it could take up to a year to plan it. There’s a lot of things that go on behind the scenes. On the clinical side, you have to identify what your benchmarks are, what your goals are for the program. What are the reasons why you want telehealth in the building? Get those benchmarks down and then track that as the program goes on. Of course the big concerns out there we don’t have the IT connectivity, you know, telehealth technology doesn’t work in our building.

David Darr (08:50):
Things have really progressed a lot over the years. And that in most cases, if it’s a wireless virtual tool that you have, if your cell phone works in a building, you’re going to be able to have telehealth in that building as well. On the front side of it, it’s all about staff engagement, letting your staff know and understand what the goals are. Not only with the residents and the primary care physicians, but with your telehealth partner. And then also what we found is that provider buy-in is important. Those local providers, these are their patients, their residents, they wanna make sure that we’re filling in the gaps appropriately. And with what we’ve seen over the last 18 months with COVID at least we’re seeing that the buy-in on providers are really seeing more of a collaboration than competition when it comes to taking care of their patients.

Amber (09:37):
What we’ve seen with this increase in telehealth is that if it’s used effectively, it can result in reductions in ER visits and reduce readmissions, which causes more unnecessary COVID exposure. It can also empower the frontline staff and improve the resident and family experience. But I can imagine that this still seems very overwhelming and maybe a little bit far off for some communities, even though these solutions are already available and ready to be implemented. Can you share some insight into specifically what the options are that a community or a home care agency may be looking at as available and what would be some of the differences between these?

Josh Hofmeyer (10:17):
Yeah, absolutely. Amber, that’s a great question. A lot of people need to realize that as Dave was mentioning, it’s important to plan and figure out what your needs are and are you ready? And, and once you know what those needs are, then you can start what I would say, shopping for what services are going to help support those needs and what technology then goes along to help support those services. So I always encourage people to first figure out what those needs are. And then look at the services that are out there. Telehealth companies provide anything from 24/7 urgent care clinical support access, to after hours support, to specialized programs, such as behavioral health or wound care, or something along those lines. And then when you know what that’s going to be and what services you’re going to go after, you can then start figuring out what technology needs to go along with those services.

Josh Hofmeyer (11:15):
And so in today’s world as most people well know, there’s a lot of technology out there and you could really spend a lot of time looking at that technology and trying to figure out what you need. And so trying to shop around and figure out the, the right solution is important. Do you need video capabilities for what you’re gonna be doing? Most of the timet the answer to that is ‘yes.’ It’s much easier for a provider to do telemedicine services when they have those video capabilities and they can see the patient that they’re looking at. Then there’s also the questions around, do we need any remote patient monitoring equipment? Or do we want peripherals that connect through the video equipment so that we can maybe use the stethoscope to listen to heart and lung sounds, or use an otoscope if we need to look into someone’s throat or into their ears if they’re having issues?
So that’s some of the examples of what’s out there. It’s a wide variety of services and a wide variety of technology that truly help support those services.

Dave Darr (12:20)
And I’ll just add to that, Amber, you know, when we visit with communities around the country, the goal is to really fill in that gap of service. So telehealth isn’t really going to replace any services that they have. It’s really going to compliment what they have in their building or further support them. As far as specialty services, that could include the behavioral health. It could include wound care. It could include social work, care transitions in those advanced care planning. You don’t have to have a big need in a building, but sometimes those, you take care of those smaller needs and then you can kind of grow into a larger, more comprehensive telehealth program.

Amber (13:00):
Do you have any insights that you can share with our listeners around the reimbursement for telehealth and how that has changed with COVID?

Josh Hofmeyer (13:08):
Yeah, so prior to COVID. First of all, let me say that the reimbursement is payer specific. And so you need to know the payers that you’re working with and what their rules and regulations around the reimbursement for telehealth are. One of the biggest ones, of course in the industry that we work in with seniors is Medicare and Medicaid, and knowing what the CMS rules are and what the state Medicaid rules are when it comes to billing. And prior to COVID, whether it was the CMS payer sources of Medicare and Medicaid, or it was other insurance companies, Medicare replacement plans, those types of things. It was rather limited on the reimbursement options for billing through those payers for telehealth services. You had to be in a rural designated location. It could not be urban. You had to be in a qualifying originating site, such as a skilled nursing facility or a clinic.

Josh Hofmeyer (14:06):
It could not be a person’s home or an assisted living or other settings such as those. You could only have an encounter with certain CPT codes billed once every 30 days or so, depending on what it was. And so when COVID happened and the public health emergency came out, they really started to look at how can we keep these people from that unneeded exposure, as you referenced earlier Amber in our conversation, and having to health and telemedicine capabilities was key to that plan. So they opened the doors and eliminated a lot of those restrictions on the payer side. And so you saw CMS coming out with allowing any location to truly be an originating site. You saw those 30 day qualifications, or if it was a billing code for one third, 14 days, those things go away and they were able to more freely use telehealth and have more frequent visits as needed. A lot of the other private payers and different things too started opening their doors a little bit.

Josh Hofmeyer (15:14):
And now we’re still in the pandemic. There’s still a long road ahead with COVID, but as we start to hopefully turn the corner, everyone’s starting to say, well what now? What are these payers gonna do? What is CMS gonna do? And actually just in the last few days, CMS did release a new final rule for Medicare and Medicaid for 2022. And they’re saying that their telehealth billing changes are going to stay in, in effect until December of 2023, because it takes legislative action to truly change these rules and regulations. But with this public health emergency they can push out what they’re doing to allow time for research, to be done and see what the impact the telehealth actually have been the last couple of years with these lifted restrictions. So it’s a complex world. Certainly something that you have to do your homework on, talk with the experts, get a really good understanding of it so that you know, what the reimbursement’s going to look like based off of what we just talked about with the services you select and the type of technology that you’re considering.

I imagine that all this information is a little bit overwhelming to any listeners who may not have started down this telehealth journey yet. To put things in perspective. Could you share a specific story or case study about a client, maybe share a little bit about where they were before telehealth, how they actually went about implementation and then some of the outcomes?

Dave Darr (16:47):
Sure. We’ve been rolling out a lot of buildings over the last 18 months. Just for reference here at a value care, we provide kind of the soup to nuts. We do everything for the telehealth. We’ve got physicians, a full geriatric team of nurses, pharmacists, social workers, behavioral health specialists, wound care specialists, so we can handle pretty much anything. So just depending on what that specific community needs is kind of how we set up that program. We did a lot of go lives, adding new services to new buildings virtually of course we just rolled out a small assisted living building in Alaska. We’re in the middle of South Dakota, all of our clinicians are located here. And so we really had an opportunity to reach out and help anyone anywhere.

David Dar (17:38):
So just this morning, Josh and I were in the clinical hub doing standup, finding out what’s going on. And we had a phone call at 3:00 AM last night from a universal care worker that had just started working there two weeks ago, so she hadn’t been quite fully trained on what the telehealth capabilities were in the building. And so she called in not really paniced, but the nurse said call in and, and Avel can kind of help out. Well our nurse picked up the phone right away, kind of found out what was going on. She was able to give her a quick tutorial on our cart review all the peripherals, kind of explain what our role is and, and helping out. And within a few minutes we had that resident up on video and we were able to do a video consult and ask some questions and look into their EMR to find out what was going on with them and address the issue right away.

David Darr (18:33):
So in that area there, like most parts in the United States staffing concerns are a big deal. Not having to send a resident out because of a small issue is a big deal. And we were able to kind of help out in a big way. It was a small situation up there, but in the end, it turned out to be a pretty big deal for that building. We just found out that the clinical concerns that we had were address right away and we’re moving on and we’re waiting for the next call from them.

Josh Hofmeyer (19:03)
It certainly can be overwhelming though, as you said. And I think that’s why it’s important when you’re looking to pick a partner for your telehealth that you find a team that has done this work before, can help you walk through this implementation, is there to help train your clinicians because you do have that staff turnover at times, and you need to know that they’re gonna have a reliable source that they can, that they can go to.

Josh Hofmeyer (19:30):
And the example Dave shared is just one of hundreds that happen each and every day with the work that we’re doing here at a Avel. And I would also just throw out there as people think about, “well, what would we use telehealth for?” Besides Dave’s example, we get calls on a variety of different things, anything from acute changes in condition, like what was going on at this resident in Alaska last night, to falls and needing to do an assessment to make sure there’s no injury, medication questions and issues, behavioral health, skin concerns, exacerbation of some of the comorbidities that they might be dealing with such as congestive heart failure, or COPD, or diabetes. So the list goes on and on, but I just wanted to share some examples. So people also had an idea of the types of things that you can truly handle from a telehealth perspective.

Amber (20:24):
That’s really great insight. I think that’ll be really helpful to our listeners. And it’s also really exciting. I think the widespread adoption of telehealth is one of possibly the silver linings of the COVID pandemic. One last question I have for both of you, what excites you the most about the future of technology in senior living?

David Darr (20:45):
Well, I’ll start with that. I think the title of this podcast today says it all, Telehealth is Here to Stay. I mean, at aVel we’ve been doing this for well over 25 years, and there’d be times that we were wondering, “do people get it? Do they really understand what telehealth is all about?” And it is here to stay and part of that on the technology side, at least Amber, with how it is we can, we can take telehealth anywhere. The use of the peripherals is wonderful. I mean with our system, we have a stethoscope. We can listen to the heart, the lungs, the stomach, the bowels, you name it, the dermcam, the otoscope, tongue depressors, blood pressure. I mean, it’s as if you’re there having a full assessment with that patient, but there’s a lot of things going on now.

David Dar (21:31): We have access to a multi call. So if we’re doing a social work encounter, we can bring in family members from other parts of the country to sit in on that call. So that’s a wonderful thing. But they’re adding EKG machines, scales. So this is going to go from the stiff world to the assisted living world, to home health and hospice down the road. So it’s going to be available to almost anyone for any reason at all. So that’s, that’s probably the most exciting part about it is that this technology is helping sell the service and show up front and close just how well we can help.

Josh Hofmeyer
Yeah. And I would just add on what excites me besides everything that Dave just shared is the true impact that it has on access and quality of care and making sure that patients are getting that quality of care that they need, and that it’s a accessible when they need it versus having to wait. And as we see workforce shortages and more and more providers retiring or changing careers, that access becomes harder and harder. And telehealth is one way that we can broaden that perspective and have support there for more and more people. It could be for the residents that we’re serving through Avel, it could be for our families. It could be for any of us that are doing this podcast today. At some point, you’re gonna need that access and need that service, and it might be telehealth that helps you get it in a timely fashion.

Amber (23:09):
Dave and Josh from Avel eCare. Thank you so much for joining us today on today’s episode of Raising Tech, really appreciate all the insight and knowledge you shared with our listeners. And thanks for joining us today listeners.

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