The Virtual House Call

Mention the future of home care, and providers will always bring up the topic of baby boomers. Much is known about who the baby boomers are, but what about the social characteristics of the physicians and other health care professionals who will be caring for this aging demographic?

According to telehealth advocates, today’s physicians are more technologically perceptive than ever, and gaining their referrals will require HME providers to be just as hard-wired. And, they say, DME dealers can benefit from the burgeoning trend by providing the equipment necessary to run a telehealth program.

These programs not only speak to tech-savvy physicians, but they also keep patients home longer and out of hospitals and emergency rooms while saving home care businesses money on home visits. Telehealth programs also are able to attract business from other areas.

Sentara Home Care Services is an HME provider that jumped on telehealth early on. The Chesapeake, Va.-based provider was the first company in the region to implement a telehealth program as well as to negotiate reimbursement for the services from a major third-party payer. The company says salespeople are using telehealth to differentiate Sentara from its competitors because no other businesses are yet using this kind of technology.

“It gets our foot in the door at physicians’ offices,” says Rhonda Chetney, MS, RN, director of clinical operations for Sentara. “We’re dealing with a lot of younger physicians these days who grew up playing Nintendo, and they feel confident taking care of patients this way. The program certainly has brought us other referrals.”

JCAHO-accredited, Senatra is the largest integrated health care provider in Southeastern Virginia. With five locations, the company provides home medical equipment, respiratory services and infusion therapy, nursing and social services. Sentara also operates six acute care hospitals and one extended stay hospital. But telehealth is the program that is helping the company grow.

“We threw our hats in the ring by stepping out into the technology world,” says Ray Darcey, Sentara’s vice president. “Telehealth is an essential component of health care delivery today, and we want to be part of that.”

The company’s four-year-old telehealth program targets four areas of home care: wound care, pediatric asthma, chronic heart failure and hospice. Each program is interactive, meaning that a PC-based system with a monitor helps patients communicate with nurses and specialists manning a centralized computer.

Every home unit comes equipped with a blood pressure cuff and stethoscope, then extras, or what the company calls “peripherals,” can be added depending on the type of care needed. Peripherals include pulse oximeters, blood glucose devices, electronic scales and tools for detecting blood clotting.

A nurse takes the unit to the patient’s home for the first visit and provides instruction. Each machine, requiring only electricity and a telephone line, has only one button that patients need to push. According to Chetney, the oldest telehealth patient is 93.

“Patients love using the technology,” Chetney says. “They take on these self-care attitudes, and when we’re not checking on them, they can check on themselves.”

Good Results

Chetney says the benefits of using an interactive telehealth program include lower health care costs, but more significantly, better recovery rates and increased self-esteem for patients.

Results from Sentara’s Cardiac Connection program, specifically for patients with chronic heart failure, show an 82 percent decrease in hospital admissions and a 77 percent decrease in ER visits. Administrators report that patients feel less depressed as a result of the telehealth program, are eating and sleeping better and feel like less of a burden to their families than before the virtual visits began.

“If we’re keeping them out of hospitals, we’re keeping them more healthy, and they don’t feel sick anymore. A lot of people feel telehealth is less intrusive,” Chetney says, adding that the emotional benefits are particularly high among hospice patients.

The hospice program is new for 2004 and is intended to provide patients and families more support as loved ones choose to die at home. The program allows social workers to make virtual house calls through telehealth units.

“There’s a lot of anxiety for families, so we’re trying to use telehealth to reduce it until the family can get used to dealing with end-of-life issues they have,” Chetney explains.

On the business side, the telehealth program is proving to be lucrative for Sentara, which grossed $67 million in 2003, up 11.7 percent from $58 million in 2002. “Telehealth fits in perfectly with Sentara’s philosophy of providing excellent patient care, while allowing us to grow our bottom line at the same time,” Darcey says.

After startup costs, which Chetney says depends on the vendor but can be up to $200,000 for 15 units, a company can expect a hefty return on its investment. “A telehealth visit costs about one-third of a home visit, so the most expensive thing we’re doing is sending the nurse out for the initial visit,” Chetney explains. Sentara’s program combines real home visits with virtual telehealth visits, but once patients start showing results, in-person visits generally taper off.

As the baby boomers age and the home medical field looks for better ways to care for them, telehealth stands as a realistic way of doing business and serving the home-based patient population.

Sentara plans to expand its telehealth program and is committed to improving patient outcomes. “I truly believe telehealth is the future of home care,” Chetney says. “Studies show telehealth provides great outcomes, and people like it and people can use it.”