​There’s a reason why some skilled nursing facilities have one star and others have five, or why some struggle to maintain census and others are nearly full and selective about which patients they admit. Some are just better than others.

In several decades of providing care in skilled nursing facilities, I’ve learned a lot about balancing the need for better care with the need to earn a profit. Most important, I’ve learned that improved care and improved profits are not concepts that are at odds with each other. On the contrary, they are essential and totally complementary. Facilities that accomplish this are the ones with all the stars, the full census, the selective admissions counselors, and yes, the most impressive profits.

When I pioneered telemedicine in nursing homes, the goal was to reduce hospitalizations. If a doctor could see the patient at 1 AM and determine if they could be safely stabilized at the facility until morning, then the patient would be kept safe, the facility would save on staff and transportation costs, census would be maintained, and a lower hospitalization rate would help improve their reputation. That service continues today, and is expanding to other levels of post-acute care and even into private practices.

The big change in telemedicine is the extent to which providers have embraced technology, how aggressive they have been about innovation, and how well they balance profitability and care. Most don’t. They continue to provide a valuable but limited service. Let’s start with this premise: Patients that are treated regularly by their own primary care physician will fare better than those who are not.

No one really disputes that, but the cost is prohibitive. Enter innovation. At TapestryHealth, we started with this premise and then figured out how to accomplish it through technology, business savvy, a deep understanding of all aspects of the skilled nursing environment, and a desire to see our patients get what they need. What we realized, is that technology actually lets us take a step back to a time when doctors still made house calls.

Build Around the Clinician, NOT Around the Technology

There is no better alternative to a patient seeing their own clinician, which is why we build our services around the clinician. Technology is a tool; a very valuable one, but it is not the care provider. That is still the domain of doctors, nurses and nurse practitioners. The shortcoming of traditional telemedicine is that it is built around the technology. At TapestryHealth, each facility is assigned its own trained clinician with geriatric and behavioral care experience. That clinician gets to know and build a relationship with each patient. They work closely with the facility staff, helping to train them on examination, evaluation and treatment techniques, and even meet with family members. The result is the kind of trusting doctor/patient relationship that is missing for so many nursing home residents.

Now, enter technology. In some cases, the most efficient delivery is for our clinician to work on-site in the facility, but typically, especially in smaller, rural facilities the clinician works remotely. And it’s common for facilities to utilize a combination of both to provide complete 24/7 coverage.

RosieTechnologically, we’ve come a long way from the early years of telemedicine. Our clinicians have access to multiple hi-def cameras to closely examine wounds down to the smallest skin tear. An integrated digital stethoscope provides crystal clear transmission of blood flow, breathing and an integrated otoscope allows for examinations of the ears, nose and throat. Digitally recorded vital signs are guaranteed accurate and uploaded in real time to the facility’s Electronic Medical Records system.

Assigning a dedicated clinician to a facility, including a dedicated after hours support team and providing them with the most advanced technology in the business are three things that separate leading telemedicine providers from the legacy providers. But there’s more, and it’s equally valuable. A dedicated clinician means daily rounds, wellness check-ups, appropriate follow-up, even admissions intake and transition-to-home care.

Specialists Can’t Help You If You Can’t Get in to See Them

Seeing a specialist is one of the most difficult appointments to get. If you’re a Medicaid patient in a suburban or rural SNF, your chance of seeing a specialist while there’s still time to take effective action is slim. Yet this is a population that needs the attention of specialists maybe more than any other. So, we bring specialists right to the bedside whenever needed. Cardiologists, pulmonologists, urologists, endocrinologists, even psychiatrists can all be brought to the patient’s bedside by their clinician, who also coordinates all specialist visits and oversees medication reconciliation. This doesn’t just enhance our service, it saves lives, and it’s all made possible – and profitable – through technology.

What’s Next?

What’s next is already making an appearance. The traditional telemedicine treatment cart is evolving to support remote medical technology that allows us to measure vital signs and upload them to the EMR in about one-third the time it would take a nurse. But we don’t stop there. Our clinicians look at any anomalies on every patient’s vitals and can immediately alert the facility if one or more readings indicate a possible problem. Potential disasters, like an outbreak of flu or Covid-19 can often be see coming days in advance of visible symptoms, allowing the facility and staff to prepare. Testing is already underway on our newest remote technology, robotic treatment carts, which will enable remote clinicians to navigate the facility and see patients without the assistance of a staff nurse.

Using today’s technology efficiently and effectively, helping to innovate tomorrow’s technology now so it meets the changing needs of post-acute care facilities, establishing a familiar clinician as the central point of care to oversee and coordinate a patient’s care: these are the difference makers that have elevated independent care far beyond what was expected when telemedicine began. Today telemedicine is a vital tool in post-acute care and a major contributor to increasing reimbursements, reducing hospitalizations and stabilizing census, improving CMS star ratings, and enhancing reputations with local hospitals, all of which provides the balance between improved care and improved profitability. Not every provider can promise all this. Can yours?

Dr. David Chess is a geriatrician who pioneered the original concept of telemedicine. He has spent much of his career since then advancing the use of technology to improve both patient care and profitability in SNFs. He is the founder of TapestryHealth, one of the nation’s leading providers of healthcare in skilled nursing facilities.