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Focus on new approaches, serving more patients
(Editor’s note: This is the second installment of a two-part series that looks at telemedicine in home health. In the last issue, representatives from two agencies described their programs and specific issues related to choosing technology and patients who are appropriate for telemedicine. This month, tips on funding telemedicine programs are presented.)
The opportunities for telemedicine in home health are exciting in both the clinical area and the funding area, according to Robert Waters, a health care attorney who specializes in telemedicine issues with Arent Fox in Washington DC. "It is becoming clear that telemedicine is one way to improve home care monitoring and avoid hospital admissions," Waters says. "Home health agencies that serve high-risk patient populations can use telemedicine to increase the number of contacts with patients without increasing the number of actual visits," he explains.
Because the initial investment in telemedicine technology is a stumbling block for many home health agencies, Sandy McNeely, RN, MSN, telemonitoring project manager for the Visiting Nurse Association of Houston, suggests agencies seek grants to fund demonstration projects that will enable them to purchase the equipment. "I was able to obtain grant funding from a local organization to enroll an additional 50 patients to our program to monitor cardiac care patients," McNeely says. This represents 50 more patients for the program with a minimum of investment from her agency, she adds.
Because grants are designed to meet the needs of underserved populations or to add to the knowledge telemedicine effectiveness, it is important to write your grant proposal in such a way to show how your project will meet these goals, Waters suggests. "A proposal should demonstrate a new approach, investigate the effect on a particular patient population’s outcomes, enhance services already offered, or accumulate data that will add to our knowledge of telemedicine," he says. You also need to define the significant effect your project will have on the health of people in your local area, or nationally, if your project has national significance, he adds.
As you pursue grant monies, be sure to keep a few things in mind, Waters recommends.
• Make sure your agency is committed to the project. Commitment and support need to run throughout the entire organization, Waters says. Make sure that all areas of the agency — clinical, business office, and administration — understand the project’s goals and the reporting requirements that are a part of the grant, he adds.
• Designate a project manager. You need one person who is passionate about the project and will oversee the details of the program and reports back to the grant organizations, says Waters. A project manager will ensure that good fiscal controls are in place and that all members of the team know what is happening, he explains.
• Know how you will handle the program after the grant expires. The length of grant awards varies according to the original grant, the funding organization, and the results of your program, Waters points out. If this is a service you intend to continue, think about how you will fund it after the grant-support years, he says. Although initial investment in equipment and training will be supported in the original program, be sure you evaluate how ongoing education, equipment maintenance, and expense reimbursement can be absorbed by the agency, Waters suggests. It is better to address these issues well before the funding ends, he adds.
There are a variety of funding sources that home health agency should investigate, says McNeely.
Check out resources
"The Office for the Advancement of Telemedicine in the Department of Health and Human Services, is an excellent resource, as are local organizations," she suggests. "Don’t forget your own hospital foundation, either," McNeely points out. "Remember that the hospital has a vested interest in reducing readmissions, so support of a telemedicine project is a win-win situation," she adds. "Don’t forget managed care and private payers when you consider financial support of telemedi-cine," McNeely says. "Because telemedicine can greatly reduce the cost of caring for some patients by avoiding readmissions to hospitals, be sure you negotiate reimbursement for telemedicine into your contracts," she explains.
Another way to make sure your reimbursement for telemedicine services is accurate and up to date, is to stay on top of changes in state and federal regulations regarding telemedicine, Waters suggests. "Organizations such as the American Telemedicine Association, the Center for Telemedicine Law, and law firms with a specialty in telemedicine do a good job of keeping current and passing the news on to home health agencies," he says.
Reducing isolation, maintaining contact
It is ironic that the modern technology that enables us to utilize telemedicine actually will enable home health agencies to provide the type of personal, old-fashioned care that people expected from physicians who made house calls, Waters says. "The ability to maintain contact via telemonitoring and the telephone will make rural homebound patients feel less isolated and less anxious, and will enable nurses to maintain contact with more patients throughout the day," he adds.
For more information on acquiring telemonitoring resources, contact:
• Sandy McNeely, RN, MSN, Telemonitoring Project Manager, Visiting Nurse Association Houston, 2905 Sackett Road, Houston, TX 77098. Telephone: (713) 630-5579. E-mail: firstname.lastname@example.org.
• Robert Waters, Attorney, Arent Fox, 1050 Connecticut Ave., N.W., Washington, DC 20036-5339. Telephone: (202) 857-6398. Fax: (202) 857-6395. E-mail: email@example.com.