Bill would support use of telemedicine at skilled nursing facilities

Proposed legislation in the House of Representatives would allow medical groups to use telemedicine to treat patients in long-term care facilities.

Proposed legislation in the House of Representatives would allow medical groups to use telemedicine to treat patients in long-term care facilities.

Proponents say using the technology to expand care access in skilled nursing facilities (SNFs) could significantly reduce hospital admissions from by permitting Medicare to enter into value-based care arrangements with medical groups to provide care via telemedicine consultations. Medicare is keen on reducing hospital admissions from skilled nursing facilities—the agency believes 45 percent of such admissions are unnecessary.

The bill is the Reducing Unnecessary Senior Hospitalizations Act of 2018, or the RUSH Act. It has bipartisan support from Reps. Adrian Smith (R-Neb.), Diane Black (R-Tenn.), Joe Crowley (D-N.Y.), Morgan Griffith (R-Va.) and Ben Ray Lujan (D-N.M.).

The bill is getting support from Health IT Now, a coalition of patient, provider, vendor, employer and insurance stakeholders working to improve quality and outcomes, while increasing safety and cutting costs.

"Roughly one in 5 patients admitted to a SNF will end up in the emergency room within 30 days and technology has an answer to this alarming trend," says Joel White, executive director at Health IT Now. “The RUSH Act will (allow) value-based contracts with medical groups that provide high-quality, on-site emergency care facilitated by a telehealth connection. This should help stem the flow of patients from nursing home to hospital by treating patients in place."

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Under the bill, the Secretary of Health and Human Services will certify skilled nursing facilities that submit an application and meet such requirements as having on-site diagnostic equipment to furnish services using telemedicine, and ensure that residents are allowed to specify their care wishes in an advanced care directive. Physician group practices also can apply for certification under the program.

Group practices must ensure that at least one clinician be present at all times at the skilled nursing facility where the group practice may furnish services. These clinicians could include emergency, family medicine, internal medicine, nurse practitioner, physician assistant or advanced trauma support specialists.

The RUSH Act includes a shared saving program under which a group practice whose participation results in a reduction in expenditures would be paid an amount equal to 37.5 percent of the estimated amount of such reductions annually, and each skilled nursing facility where the group practice furnishes services would get paid 12.5 percent of the estimated annual reductions in cost.

Not later than 2024, Medicare will determine whether the program has resulted in an increase in total expenditures; if it does, it can terminate the program.

The bill has been referred to the House Ways and Means Committee for further consideration, where sources say it has the blessing of committee leadership. Health IT Now and other stakeholders will be making a push for its passage before the end of the year.

The proposed RUSH Act is available here.

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