CMSA Today - Issue 4, 2021

TELEHEALTH COVID-19: DEEPENING THE CONVERSATION: WHY NOT HOME BY CORIN L. SCHNEIDER, MHA, MSN, RN, ACM-RN, AND DR. TIFFANY VICTOR-CASTLEBERRY, DNP, MSN, BA, RN, ACM-RN T here is no doubt that COVID-19 has necessitated an environment of rapid change in the healthcare landscape, driving patient care delivery systems beyond tradi

smart phones became the key tools of com munication for staff engaging with patients and families. Team huddles shifted from in person to virtual, texting and secure chat processes were enacted, and concise medi cal record documentation became pivotal in an effort to clearly articulate the care plan. The emphasis on length of stay (LOS) became a key focus, as COVID-19 created significant barriers to discharging patients, leading to hospital bed capacity challenges at a time when every bed was seen as a national treasure. Waivers with the intent of immediately transitioning patients to post-acute facili ties coupled with added stipends to daily reimbursement rates were not enough to move the volume of patients needed to ease the bed capacity burden. Establishing a gold standard post-acute care collabora tive network with the most engaged part ners became critical to understanding the impact of COVID-19 on their ability to accept patients and ensure safe and timely patient transitions. It became necessary to augment

traditional post-acute venues with dedicated COVID-19 positive hoteling, shelters and congregate living settings. These initiatives required conversations and collaboration between healthcare entities at local, state and federal levels to address deeply rooted barriers to transitioning patients through the healthcare continuum. While post-acute care facilities strived to continue accepting admissions from hospi tals, admission freezes for resident safety were unavoidable, significantly impacting LOS and throughput. With the inability to discharge patients to another care setting and patients fearing going to congregate living settings, the concept of “why not home” gained traction with clinical teams, care coordinators and patients. The pan demic both created a need and highlighted the effectiveness of care delivery in non traditional settings. The utilization of in home telehealth monitoring and provider telehealth visits reinvigorated and acceler ated the conversations around the concept of “Hospital At Home.” According to Cheney (2020), “hospital at-home programs provide inpatient-level care to patients in their homes such as daily supervision by doctors or nurses in-person or virtually via telemedicine. Hospital-at home programs provide a higher level of care than traditional home health services, which generally focus on skilled nursing and physical therapy.” This Medicare program for qualifying conditions has significant potential to increase hospital bed capacity, reduce length of stay and decrease readmissions by decreasing gaps in care caused by patient movement from one care setting to another. Hospitalized patients and those triaged in the emergency department would have the opportunity to participate in hospital level home-based care. Case management will Continued on page 30

tional management of length of stay, bed capacity, and slower adoption of some tech nologies. The pandemic created an immedi ate need to look through a new lens to meet the complexities around care coordination for hospitalized patients ensuring safe and sustainable pathways beyond the acute care setting. Now more than ever, the expertise of case management is being leveraged and at the forefront of care delivery. Addressing length of stay challenges, enhancing col laboration, and integrating technological concepts have been and will be paramount to ensuring patients remain at the center of care. With the influx of COVID-19 patients into hospitals, many case managers almost immediately began working remotely or away from the medical units. The utiliza tion of technology, telemedicine, iPads and

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CMSA TODAY

Issue 4 • 2021