Executive Decisions: In-house emergency med tech keeps the doctor away

A telephone call out of the blue has helped 202-bed Central Island Healthcare slash its rehospitalization rate, capture about $150,000 in bonus government payments and earn a No. 1 rating among the nation’s 15,000 certified skilled nursing facilities. The secret ingredient for this metro New York provider? Embedded paramedics who connect with off-site, contracted physicians via telemedicine. McKnight’s Editor James M. Berklan spoke with CIH Executive Michael Ostreicher about the startling results.

Podcast: Why Tim Peck Built Call9 A Platform That Reinvents The 911 System

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Today marks one of the most exciting milestones in the history of 20 Minute Fitness. We’re bringing you the very first episode of ‘Why I Built This’, a mini series introducing innovations that are revolutionizing the health & fitness industry and of course the master minds behind them.

On our first episode we had the pleasure to sit down with Tim Peck, who left his Chief Resident position at Harvard Medical School and moved to Silicon Valley to build Call9, a platform that can reinvent the 911 system. Although most people thought he “lost his sanity” at that time, Tim has proved all of them wrong. Call9 has already delivered life-changing care to over 3,500 patients and this is just the beginning.

Call9 Helps SNF Partner Achieve Maximum Bonus for Value-Based Purchasing Program

Central Island Healthcare Joins Elite Class of SNFs to Receive CMS Reimbursement

BROOKLYN, NY (November 29, 2018) – Call9, a telehealth pioneer for the nursing home industry, responded today to new data released by the Centers for Medicare & Medicaid Services (CMS) that provides facility-specific performance information for the fiscal year 2019 Skilled Nursing Facility Value-Based Purchasing Program.

Central Island Healthcare (CIH) in Plainview, NY—the first facility Call9 partnered with—was one of only 3% of SNFs to receive the maximum bonus of 1.6% for improved 30-day readmission rates back to hospitals. CMS compared a baseline period of calendar year (CY) 2015 with a performance period of CY 2017 to determine whether a facility received a bonus or penalty. Of the nearly 15,000 SNFs included in the program, only 27% received a bonus, and 73% were penalized.

Since its implementation in 2015, Call9 has worked in partnership with CIH staff to provide a superior level of care for residents who might have previously been sent to the Emergency Department with conditions that Call9’s solution treats in place. Central Island experienced a 44% reduction in hospital transfers as a result of Call9, which provides technology that connects embedded emergency-trained first responders—who work on-site in the facility 24 hours a day, 7 days a week, 365 days a year—to remote Emergency Medicine providers to deliver care at the bedside for patients experiencing an acute change of condition.

Timothy C. Peck, MD, Call9’s Cofounder and CEO, released the following statement:

The recent data released by CMS regarding the Skilled Nursing Facility Value-Based Purchasing Program identified that nearly three-quarters of skilled nursing facilities were penalized for poor 30-day readmission rates. This reflects the shift to value in Medicare reimbursement that will only be taking greater hold in the coming years. Call9 is proud to partner with Central Island Healthcare, our first SNF, with whom we were working with throughout all of 2017. That CIH is one of only 3% of SNFs to have received the maximum bonus reflects the strength of our partnership and the quality of Call9’s solution in helping facilities reduce unnecessary transfers and achieve a greater census of patients. As Medicare continues to search for decreased costs and improved care, the shift to value will only grow. The ability for nursing homes to care for patients in place, both by lowering 30-day readmits and providing less discontinuity of care, becomes even more important. Call9 is excited to continue working with CIH and other like-minded SNF partners to deliver value to patients and to the healthcare system.

Michael Ostreicher, Executive Director of Central Island Healthcare, contributed this statement:

Call9’s impact on our patient care has been dramatic. In conjunction with our team of dedicated staff, Call9's technology and services solution allows for vastly improved coverage for our residents, which results in better outcomes for them, less stress for their families and more resident days for CIH, all at a lower cost to the healthcare system. We are thrilled to be identified as one of the best SNFs in the country in terms of the value we’ve delivered to the system and to our residents, and we are grateful for the Call9 team for the many ways they drive value to our facility on a daily basis.

About Call9

Call9 provides Emergency Medicine without brick and mortar limitations. Call9 humanizes telemedicine by connecting on-site, emergency-trained first responders to remote physicians, delivering care to patients at their bedside in nursing homes and rehabs. The company’s embedded care model approach is a replacement of 911 and subsequent hospitalizations and readmissions, lowering healthcare costs while improving care outcomes. Learn more at call9.com.

Call9 Partners with Lyft to Provide Transportation for Family Members of Nursing Home Patients

Integrated Application Will Enable Call9 Partners to Provide Reliable On-Demand Rides and Improve Overall Patient Experience

BROOKLYN, NY (November 13, 2018) – Call9, a telehealth pioneer for the nursing home industry, and Lyft, whose mission is to improve people's lives with the world's best transportation, today announced a partnership that will provide an enhanced transportation experience for family members visiting patients living in the skilled nursing facilities where Call9 operates.

As a result of the partnership, Call9 physicians and on-site emergency-trained first responders will be able to schedule on-demand Lyft rides for family members—even those without the Lyft application—directly through its Concierge platform integrated into Call9’s proprietary dashboard. The program will strengthen communication with family members when patients are experiencing an acute change in condition and offer reliable access to patients in an emergency situation - providing families with peace of mind that they will be there when their loved one is in need.

“Call9 can bring our emergency medical providers to the patient’s bedside within minutes, and now Lyft will help us ensure that their family members arrive in a reliable, efficient and comfortable manner,” said Timothy C. Peck, MD, Call9’s Cofounder and CEO. “We founded Call9 to be with patients at the moment of their emergency. Being able to offer them and their families one less thing to worry about so they can focus on important healthcare decisions is something we’re really proud of. Our partnership with Lyft is a unique opportunity to integrate our resources to provide a new, concierge service that transports family members to where they’re needed the most.”

Currently, Call9 covers more than 3,700 beds in New York state. Since 2015, Call9 recorded nearly 100,000 first responder visits and over 21,000 telemedicine visits, reducing unnecessary Emergency Department visits, hospitalizations and subsequent readmissions in nearly 80% of patient encounters.

“At Lyft, we're focused on improving people's lives with the world's best transportation,” said Gyre Renwick, Vice President of Lyft Business. “Together with Call9, we're making it easier for physicians to schedule rides for patients’ families through Lyft Concierge, helping to deliver better care to elderly patients by easing the burden on their loved ones.”

About Call9

Call9 provides Emergency Medicine without brick and mortar limitations. Call9 humanizes telemedicine by connecting on-site, emergency-trained first responders to remote physicians, delivering care to patients at their bedside in nursing homes and rehabs. The company’s embedded care model approach is a replacement of 911 and subsequent hospitalizations and readmissions, lowering healthcare costs while improving care outcomes. Learn more at call9.com.

About Lyft

Lyft was founded in June 2012 by Logan Green and John Zimmer to improve people’s lives with the world’s best transportation. Lyft is the fastest growing rideshare company in the U.S. and is available to 95 percent of the U.S. population and Toronto, Canada. Lyft is preferred by drivers and passengers for its safe and friendly experience, and its commitment to effecting positive change for the future of our cities.

About Lyft Business

Lyft Business offers travel, commute, event, and courtesy ride solutions that provide customers with the tools they need to reduce cost, save time, and streamline their transportation programs. We partner with thousands of organizations to create unique solutions to move their people, from employees and customers to patients and students. To learn more about Lyft Business, visit lyft.com/business.

Why this startup co-founder lived in a nursing home for 3 months

Though he's a doctor, Timothy Peck didn't know anything about nursing homes. So he decided to live in one and learn more as he started Call9, his company that uses technology to bring care to the bedside of nursing home patients.

Call9 is a startup based in New York City. Its co-founder and CEO, Timothy Peck, is an emergency physician by training. While serving as chief resident in the emergency department at Beth Israel Deaconess, he noticed he and his colleagues weren’t able to deliver the best possible care to older patients.

In a phone interview, Peck cited a statistic: 19 percent of ambulances that come to the emergency department originate from nursing homes and rehab centers. After these elderly patients arrive at the hospital, they often become delirious from the change in location and begin to feel sick. They then have to wait while physicians order tests to figure out what’s wrong.

Overall, these avoidable ED trips are harmful to patients and costly to the healthcare system.

Peck wanted to do something about it, but there was one major problem: He didn’t know anything about nursing homes. As a medical student, resident and doctor, Peck had “never once set foot in a nursing home,” he said.

  Photo: jacoblund, Getty Images

Photo: jacoblund, Getty Images

Thus, he endeavored to change that. Peck lived at a nursing home on Long Island for three months. During his time at Central Island Healthcare, he slept on a cot in a conference room and experienced the various elements of the facility, from seeing how the food was made to meeting with the CFO.

While there, Peck also set up an experiment to see what the nursing home was like in the middle of the night. He set an alarm for 1 a.m. one night, 2 a.m. the next night and so on. Each time he got up and walked around, but never once did he see a physician.

“You assume as a consumer … that there are physicians there, but there aren’t,” he said. That was the biggest lesson he learned from the experience.

“It changed the trajectory of my life,” Peck added. “You can’t really go back after seeing the problem firsthand.”

The knowledge gained from his time in the nursing home assisted him as he continued to build Call9.

Here’s how the startup’s approach works: It places a first responder in nursing homes 24/7. They attend to the patient whenever there’s a change in his or her condition. The first responder can then use Call9’s technology to bring a remote doctor into the loop. The doctor can see, diagnose and treat patients, thus avoiding unnecessary ED trips.

Peck said about 20 percent of the patients Call9 treats end up going to the ED, but the other 80 percent are able to stay in their own beds in the nursing home.

The company participates in value-based arrangements with payers. It also contracts with nursing homes. “They pay us a platform fee for the utilization of some of our consulting services that are not covered by the payers themselves,” Peck said.

New Medicare Advantage Telehealth Rules Signal Growing Skilled Nursing Opportunity

New guidelines that could open up telehealth coverage under Medicare Advantage represent a serious opportunity for the industry, according to multiple technology providers — especially as the moves signal growing support for remote care from key federal officials.

Under a proposed rule released late last month, the Centers for Medicare & Medicaid Services (CMS) would include telehealth services as part of the basic, core offerings for which Medicare Advantage plans can receive government reimbursements.

The current structure forces Medicare Advantage plans to budget internally for telehealth services, according to Timothy Peck, co-founder and CEO of Call9, a platform that “embeds” emergency medical technicians in skilled nursing facilities and enables direct communication with remote doctors. So even if a plan determines that the use of Call9 or other telehealth technologies can produce savings in the short term, it’s forced to take on all of the financial risk.

But the new rule, set to take effect in calendar year 2020, would provide for the direct reimbursement of telehealth services under Medicare Advantage regardless of location; currently, traditional Medicare only covers remote health tech in rural facilities.

Telemedicine reduces hospitalizations from 154 per six months to 85 at skilled nursing facility

Central Island Healthcare now is able to regularly treat common ailments among residents such as hypertension, fever, chest pain and COPD in place, rather than sending patients to an emergency room.

THE PROBLEM

"All nursing homes are dealing with the challenge of trying to care for higher acuity patients with resources that are limited by the reimbursement we receive for care of their conditions," said Michael Ostreicher, executive director of Central Island Healthcare.

"I had been thinking about ways in which we might provide that superior level of care and just as I was setting myself to solving this problem, I received an email from Call9 proposing the solution I'd been seeking," he said.

PROPOSAL

Call9, a telemedicine vendor, proposed providing on-site emergency trained first responders 24/7 to Central Island Healthcare, said Ostreicher.

The company works collaboratively with the nurses in the healthcare facility to provide an extra layer of support that's designed to allow on-site nurses to provide for the chronic care needs of patients. Those experiencing an acute change of condition are privy to Call9's services rather than having to be transferred to the emergency department – unless they're experiencing serious events such as strokes or cardiac arrest. In those cases, they're transferred, but with early intervention measures, offered via telemedicine, that help ensure better outcomes than they would have had without telemedicine.

 Central Island Healthcare, a skilled nursing facility in Plainview, New York, wanted to provide a superior level of care for residents in its facility who were being sent to the emergency department with conditions it believed it might be able to treat in place.

Central Island Healthcare, a skilled nursing facility in Plainview, New York, wanted to provide a superior level of care for residents in its facility who were being sent to the emergency department with conditions it believed it might be able to treat in place.

Call9's technology and services would allow for improved coverage for Central Island Healthcare residents, which would result in better outcomes for them, less stress for their families and more resident days for the facility – all at a lower cost to the healthcare system, Ostreicher said.

MARKETPLACE

There are many vendors on the market today that offer telemedicine technology, including American Well, Avizia, GlobalMed, MDLive, Novotalk, SnapMD, Teladoc, TeleHealth Services, Tellus and Tyto Care.

MEETING THE CHALLENGE

The telemedicine technology complements the workflows and abilities of Central Island Healthcare's team of nurses and caregivers, said Ostreicher. Call9's on-site team is part of the facility's care cooperative; the facility's team and residents are connected with them, and everyone works together to provide a comprehensive care solution when residents experience acute needs.

"When a resident experiences an acute change of condition, our staff activate Call9, their clinical care specialist goes to the resident's bedside with a suite of diagnostics designed for acute care, huddles with our nurse, connects with a Call9 remote physician, and begins caring for the patient's needs via the direction of the doctor," Ostreicher explained. "We've seen a drastic reduction in hospital transfers as a result of this, and our residents experience a far greater quality of life because of it."

RESULTS

The impact on patient care has been dramatic. In the four six-month periods prior to Call9's implementation, the healthcare organization was averaging 154 hospitalizations per period. In the four six-month periods after the implementation, the organization has averaged 85 hospitalizations per period.

"With telemedicine, our patients are able to be seen by a physician within five minutes of identification of their acute change of condition – median time from activation – and the team is able to regularly treat common ailments among our residents, such as hypertension, fever, chest pain and COPD in our facility," Ostreicher said.

Since implementation, Central Island Healthcare has seen a consistent 40-50 percent drop in emergency department transfers, a greater census of patients, and greater satisfaction among both residents and their families, he added.

ADVICE FOR OTHERS

"The national paradigm of nursing home care is unsustainable," said Ostreicher . "It's both insufficient for the patient and more and more detrimental to the bottom line of facilities."

Two months ago, Central Island Healthcare received the first value-based purchasing program reimbursement from CMS, he said – which more than covered the rollout of Call9 services, "without even considering all the other ways the telemedicine technology drove value to our facility."

For nursing homes operating under the model of ten, or even five years ago, Ostreicher strongly encouraged them to identify and adjust to the shifting times: It's what's right for the patient and it will improve their bottom line, he said.

Getting a look inside: How big data can advance value-based care for nursing facilities

Gaining greater visibility into the day-to-day facility operations can provide SNF administrators with a wealth of information which they can then leverage to reduce the volume of transfers to the ED, improve the quality of care and reduce costs.

First and foremost, operational data can enable administrators to track the volume of transfer rates, the percentage of transfers that were avoidable, and when and why transports are taking place.

It is also important to look at the factors contributing to transfer rates so they can be systematically addressed. Facilities can start by tracking which indicators suggest patients will be transferred to the ED most often, using underrecognized data points that identify certain patients are at the highest risk of transfers. By understanding which patients are at highest risk for transfer, facilities can essentially predict emergency calls before they happen, and then take steps to reduce transfer rates by creating more tailored care plans for those patients, engaging their families and PCPs early and often, and frequently monitoring those patients’ vital signs.