Adding virtual nursing to a hospital unit can help reduce staffing needs, while improving patient outcomes and patient satisfaction. These remote nurses can document, observe, interact, train, and otherwise act as another set of hands, in often-understaffed hospitals.
The U.S. is likely to continue to deal with a critical nursing shortage for the foreseeable future. Thus, health systems are now looking for ways to more efficiently ensure that patient needs are met. Many successful health systems are turning to virtual care options to supplement, and in some circumstances enhance traditional bedside care.
Across the country, healthcare organizations are experiencing difficulty recruiting, very high labor casts, increased staff burnout, and more. The American Nurses Association noted that states were constantly challenged by unfilled positions and failure to recruit enough replacement nurses. More notably, areas and states that already experience limited access to care – such as rural southeastern areas of America – reported as many as 6,000 unfilled positions. These shortages feed on themselves, since working in a chronically understaffed setting takes its toll.
Approaching the shortage: a series of stop-gaps
Some healthy systems are using travel nurses as a stop-gap to help staff more shifts. This doesn’t exactly solve the problem as added expenses limit the long-term sustainability of this approach. Other hospitals are increasing their patient-to-nurse ratios, with some facilities relying on patient care techs and nursing aides to ease the burden. Unfortunately, thousands of qualified would-be-nurses have been turned away from nursing schools due to shortage in almost every area – and even lack of financial support.
While schools implement strategies that enable them to add student capacity, health systems must find ways to do more with less, without sacrificing care quality. With declining margins due to the pandemic, it is all the more difficult to simply hire more aides, even presuming they are available.
Besides actual procedures and hands-on care, bedside nursing includes charting, consulting with team members, accessing supplies, coordinating with other departments, and speaking with family members and friends. However, given the understaffing on many floors and units, patients often interact with a variety of care team members on each shift. This fragmentation in turn makes it more difficult for patients and their visitors to decipher “who’s who,” and to bring forward important concerns.
Dividing to conquer
The pandemic accelerated acceptance of telehealth, along with more comfort with wearables, virtual monitoring of patients via clinicians and Bluetooth enabled devices, and healthcare systems. Incorporating virtual nursing programs within acute care facilities allows floor nurses to cover more ground. Virtual patient observation, for example, can support a number of goals, from greater patient safety to an improved patient experience.
Patients have long complained about the sleep deprivation caused by clinicians entering the room, along with the background noise from nurses’ stations and hallways. In addition to the discomfort and disorientation that interrupted rest entails, when a series of staff intrusions occur with no prior warning nor way to ask questions, the patient can easily feel like an “object,” with little control over the situation — not an ideal environment for healing.
With on-demand access to nurses and supporting care team members, patients can have their questions answered remotely, allowing floor staff to be notified and physically intervene only when needed; thus systems have seen their room entry needs, often with attendant needs for PPE or other precautions, significantly reduced.
With some basic concerns addressed by virtual nurses, the floor nurses can also cultivate an improved relationship with patients, providing more concentrated time for in-person care to focus on their needs. This is obviously a more desirable situation for a high-performing bedside nurse.
The best solutions are those that address a number of pain points, and virtual patient observation is gaining traction as a core workflow. Facilities have learned that consistent monitoring and early intervention, as is facilitated by virtual observers, can reduce wandering, falls, self-harm, and visitor security incidents. Health systems can also reduce labor expenses by leveraging virtual infrastructure.
Virtual nurses: more efficient delegation and workflows
Collaboration among virtual and on-site nurses can enable floor staff to spend more time with patients at the bedside. Telenurses can address tasks such as admission and discharge planning, medication adherence and reconciliation, patient education, even monitor vitals and provide early intervention if necessary. Meanwhile, floor nurses can focus on tasks requiring hands-on and in-person skills and availability such as supervision of aidses and less experienced staff.
Virtual nurses can even train, mentor, and otherwise support bedside nurses – coaching them when needed through unfamiliar tasks or procedures. Of course, they can also coordinate communication in urgent and emergency situations, and can instantly activate alarms on the floor or from rooms.
Thus, telenursing does not solve the nursing shortage, but it can help to support optimal outcomes of care, staff development, retention and morale – and help to increase access to care and help close the health equity gap.
If you’re interested in adding virtual nurses to your health systems team learn more about Community Wellness’s Integrated Virtual Nursing Program today!
Remote patient monitoring allows for successful telehealth interventions for patients with obesity lose weight. Telehealth interventions provide a safe, remote alternative and may expand treatment access to hard-to-reach populations.
Overweight & Obesity
Approximately 75% of Americans 20 years or older are overweight or obese. Obesity is considered a chronic disease that increases a person’s risk for health conditions such as diabetes, hypertension, sleep apnea, osteoarthritis, and musculoskeletal problems. A person having a Body Mass Index (BMI) between 25 and 29.9 is within the overweight range, and BMI between 30 and 39.9 is within the obese range.
According to the Center for Disease Control and Prevention [CDC], (2022), the estimated annual medical costs of obesity in the U.S. was nearly $173 billion in 2019. Studies also indicate that medical expenses for out-patient and in-patient services are higher for obesity compared to those within a healthy BMI range between 18.5 and 24.9. Losing just 5-7 percent of a person’s body weight produces significant health benefits in lowering blood pressure and preventing or delaying the onset of type 2 diabetes. So why are people still struggling to lose weight?
The components of weight loss are multi-faceted, and research supports the best weight loss program focuses on helping others make sustainable lifestyle changes. Self-management support is essential for patients to extend health care outside of clinical walls and into their daily routines.
Community Wellness, Technology (CWC) Remote Patient Monitoring (RPM) program offers weight loss support using evidence-based FDA-approved blue-tooth devices and resources. A clinical team of physicians and clinical health coaches utilizes technology-supported daily monitoring and coaching to help adults lose weight and sustain weight loss by building healthier habits.
Health coaches provide behavioral and self-management support to lose weight using virtual 1:1 coaching 20-30 min monthly coaching sessions. The integral component to helping a patient lose weight is the collaboration and trust between a patient and health coach. The daily weight readings within the CWC app also provide feedback for both the patient and coach in measuring progress towards reaching a patient’s weight-loss goal. The app records weight, activity, SMART goals, and personalized check-ins and messaging.
Technology combined with personalized health coaching provides science-based resources and tools for successful patient engagement and self-management.
Benefits of RPM & Health Coaching Include:
- Provides the latest information on weight loss
- Teaches disease-specific skills
- Promotes behavior change
- Builds confidence and motivation
- Encourages and supports change
- Provides accountability
- Tracks and records changes in weight and BMI
Stronger Together On-Line Community Platform
Patients also learn skills around losing weight and building healthy routines using the Stronger Together (ST) online community platform. Coaches share resources and information on healthy eating, exercise, managing stress, and other health-related topics. The Stronger Together platform is a space where patients can support each other experiencing similar weight-loss challenges. Coaches are available to answer questions and provide tips on weight-loss strategies.
CWC partners with hospitals, primary care providers, and other healthcare organizations to assist patients in losing weight and improve health-related outcomes. RPM combined with 1:1 health coaching sessions helps patients lose weight and improve their overall health. CWC offers personalized weight-loss support where patients can talk with their coaches in the privacy of their own homes telephonically or virtually. Patients feel supported throughout the weight-loss journey by the CWC clinical team and patient enrollment and support staff.
Reference: CDC- Adult Obesity Facts https://www.cdc.gov/obesity/data/adult.html. May 26, 2022
Healthcare providers are, understandably, wary of new technologies since patients’ lives are – literally – in their hands. However, the benefits of remote patient monitoring outweigh the risks of early adoption. Bill Gates once stated, “There is an opportunity to speed up history at an inflection point.” He was referring to his creation of Microsoft, but those words have resonated with me during my healthcare career. Healthcare has many inflection points that are driven by new technology, public health policy, reimbursement, and expansion of services.
In late 2019, many healthcare providers suffered significant losses due to severe drops in volume caused by the proliferation of the Covid-19 virus and the resultant quarantines. These losses resulted in many hospital and healthcare providers closing operations permanently. Healthcare providers that had yet to deploy telehealth assets experienced the most severe losses. This was one of the most significant healthcare inflection points in recent history.
Telehealth inflection point
As governmental and commercial payers started to reimburse for telehealth visits, a new healthcare delivery model was created. Private equity firms and venture capitalists took advantage of this significant inflection point and created a multi-billion-dollar industry which has disrupted our local healthcare communities. Health insurance companies took advantage of this lower-cost alternative and contracted with Teladoc and other national companies to provide services directly to their customers. The reluctance of healthcare providers to embrace digital healthcare though early adoption allowed national telehealth providers to grab massive amounts of market share with a level permanency. The Covid-19 pandemic inflection point bolstered the public’s acceptance of digital healthcare delivery, broadening the digital healthcare market. History was sped up and digital healthcare became a permanent part of our delivery system.
Many health systems lost a significant long-term opportunity to laboratory start-ups that were willing to meet the massive amount of new demand. These laboratories were formed by entrepreneurs that saw the need for and capitalized on expanded laboratory services. Many of these entrepreneurs created generational wealth by taking advantage of the inflection point and sped up their own history.
Remote Patient Monitoring and Chronic Care Management
Between July 2003 and December 2007, the Veterans Health Administration (VHA) introduced a national home telehealth program, Care Coordination/Home Telehealth (CCHT). Its purpose was to coordinate the care of veteran patients with chronic conditions and avoid their unnecessary admission to long-term institutional care. The table below shows the high-level results the program achieved by chronic condition.
The program achieved remarkable results and caught the attention of healthcare policy makers. CMS began reimbursing for Chronic Care Management (CCM) and Remote Patient Monitoring (RPM) in 2015 and 2019, respectively. CMS further expanded coverage in 2022 to include Remote Therapeutic Monitoring (RTM). All these programs are delivered through telehealth assets to provide more care in the home. In addition to the telehealth visits, RPM and RTM provide FDA-approved devices for continuous and periodic monitoring of vital signs. These programs are designed to identify through health informatics changes in the patient’s well-being for earlier intervention. The trend in adding more access to care management at home is likely to increase in the future, based upon the ability to improve care quality and patient access, and lower the total cost of care.
Benefits of remote patient care
Healthcare systems, hospitals, and physicians are challenged today by staffing shortages, capacity issues, and declining reimbursement. The table below shows benefits of RPM to healthcare providers.
The case for early adoption
The current market penetration of RPM is less than one percent and is projected to be an 85-billion-dollar industry by 2026. This projected industry growth has caught the attention of healthcare stakeholders, pouring investment into healthcare-at-home initiatives. Pharmacy chains and payers are likely to quickly adopt these innovative programs and deliver through their current distribution channels.
Healthcare providers should strongly consider early adoption of an RPM solution and close this service gap sooner than later. If we have learned anything about the rise of Teladoc and the threat of the major pharmacy chains, we know the barbarians could already be at the gate.
Community Wellness is a turnkey RPM platform that requires no capital investment, and supplies the equipment, care management staff, and the technology platform to provide a simple path to early adoption.
Our colleague, Mark Hagee, recently recovered from COVID-19 and sat down with us to discuss his experience navigating the healthcare system as a patient. Mark is a healthy, active, slightly overweight 54 year old. Here is his story.
When did you begin to feel ill and suspect it may be COVID?
On September 24th, I began to experience symptoms, such as body aches, headache, fever, coughing, shortness of breath – all the classic COVID symptoms.
When I began to feel worse the next day and my wife was also ill, we strongly suspected we had contracted COVID. We scheduled a test for September 26th to confirm our suspicions and both of our tests came back positive.
How did you realize you needed treatment from a healthcare facility?
We weren’t improving with bed rest and OTC medications at home, so our doctor decided we should be treated at our local hospital with an infusion of monoclonal antibodies. He arranged for us to have an appointment later that week, on September 29th. Being in the healthcare industry, I knew my doctor was right.
What happened after your infusion?
As my wife and I were leaving after our infusions, I couldn’t breathe and was unable to walk to the elevator. We were directed immediately to the Emergency Department, where I was quickly admitted after triage. In the ED, I had a chest x-ray and bloodwork taken and was given fluids. The x-ray showed signs of pneumonia and my heart
rate was elevated (155) and my blood pressure was low, although my sat rate remained in the 90s.
After several hours in the ED, I requested to go home and the doctor agreed to discharge me. I was sent home with the usual boilerplate paperwork, even though I couldn’t walk to my car and my heart rate was still very high. Over the next few days, I recuperated at home but received no follow-up from the hospital or my PCP to see if my condition was improving.
Luckily, I have a friend who is a physician that I was able to reach out to with any questions I had and I have family close by to monitor my symptoms as I recovered. I do think, though, about people who don’t have the resources that I do.
What would you have done differently?
If you know that there’s a company out there like Community Wellness, who can help you monitor your patients while they recover at home, why wouldn’t you implement their services? I would have felt much more comfortable being sent home with the appropriate RPM equipment (pulse oximeter, spirometer, thermometer) and knowing that a clinical coach would follow up with me on a regular basis.
It is such a simple way to improve patient outcomes. The hospital can manage patients post-discharge and patients have peace of mind knowing that they are still being monitored as they recover.
A 2018 survey of America’s physicians by the Physicians Foundation found that doctors are seeing an average of 20.2 patients per day, up from 19.5 in 2014. With a standard patient load, it can be difficult to give each patient the attention they deserve. This can be even more challenging when the patient is managing a chronic condition (or more than one). One way to help manage the care of these high-acuity patients is to adopt a Remote Patient Monitoring (RPM) system.
5 things you should consider when evaluating RPM systems
Your patients’ goals
Are your patients asking how they can manage their condition(s) without multiple in-person doctor visits, especially in the time of Covid-19? Or perhaps they are trying to avoid costly hospitalizations. Also consider whether they are (relatively) tech-savvy and willing to embrace a technological solution.
=> If the answer to these questions is yes, then RPM may be a good fit for your practice.
RPM costs and revenue opportunities
While RPM typically offers cost savings in the long run, there may be initial costs that need to be considered. The Journal of Telemedicine and Telecare found that equipment purchasing, servicing, and monitoring cost of RPM programs can range from $275 to $7963 annually per patient. These costs can vary depending upon whether you opt to purchase and manage an RPM system yourself or if you partner with a third-party provider. Some RPM providers may work with you to bill Medicare and pass any insurance savings onto your practice, resulting in additional passive revenue.
=> Savings and revenue may increase down the line with a self-administered system, but you may need to bear the up-front costs associated with it. Partnering with an RPM provider may lessen downstream revenue but can eliminate start-up costs and negate the need for additional staff to manage the system.
Insurance/Medicare billing requirements
Many insurance companies and Medicare are beginning to reimburse for RPM expenses. Keep in mind, however, that there are specific requirements regarding the number of vital signs collected over a period of time and the type of device used to take the readings, as well as regular appointments with the patient.
=> Does your practice have the capability to research and administer additional billing requirements for RPM? If not, consider partnering with an RPM provider who can manage the billing requirements.
Getting patient/staff buy-in
Whether you opt to institute a self-managed RPM solution or partner with a third-party provider, there are requirements that your staff and patients need to manage. Communication is key. Clearly delineate the process so that everyone is aware that, while it may seem burdensome at the outset, RPM can improve the lives of your patients and actually decrease patient management for your staff over time.
=> Patients will need to have in-person appointments less frequently and can have the peace of mind knowing that any anomalies in their vital sign readings will be transmitted to their physician immediately.
Choosing an RPM provider
If you opt to partner with an RPM provider, rather than adopting a self-administered system, some factors to evaluate are:
- Do they have a medication adherence protocol for your patients?
- Do they provide patient coaching or simply have a technology offering?
- What is their protocol for transmitting readings outside of normal parameters?
- Do they offer a billing file and support documentation to make insurance/Medicare reimbursement simple or do they offer to manage billing on your clinic’s behalf?
- Is there a cost to partner with the provider or do they utilize a revenue share model?
A turnkey solution
Community Wellness is a full-service RPM provider that provides the devices to your patients and trains them how to track their vital signs, has a robust data analytics tool that seamlessly integrates with most EHRs, and offers a unique clinical coaching system for your patients that has shown to increase patient compliance with vitals measurement and medication adherence.
Community Wellness Chief Medical Officer, Scott Parazynski, MD, and Chief Strategy Officer, Gene Preston, presented the challenges and value proposition of remote patient monitoring (RPM) to the Kentucky Hospital Association‘s HFMA annual conference.
When your core customer is a chronically ill Medicare-eligible patient in their 70s, 80s, or even 90s, you have challenges connecting to them you might not have if you’re working with a software engineer in their prime. I kid with our enrollment team that we should screen for former Cisco, Microsoft, or Apple employees first. Tech-savvy patients are a dream but not a reality. Some are very good; some have never used a smart device. So, how do you address the challenges of Remote Patient Monitoring with this population?
First, our patients mostly bring their own device to download our tracking app, MyWellness Connect™. To get the full benefit of Remote Patient Monitoring, you need a touch screen smart device. But some patients in this segment still have flip phones. As most RPM providers use Bluetooth-enabled sensors, they need either a smartphone or tablet. One solution is to provide a pre-paired device and instruct them how to use it. It may be intimidating at first, but our coaches are very patient and trained for these situations.
We also found that some couples share the same device and/or email address. Our app can support multiple logins, but each user needs their own unique email. So, we help them set up an email account and teach them how to use it.
Remote patient monitoring video chats
Some patients haven’t used video chat before, such as Skype, Facetime, or Zoom. For the best experience and results during their coaching sessions, we’d like them to join our video calls. Many of our patients are hesitant to try new technology, which poses a challenge as we’ve found that video calls are more productive than voice-only calls. So, we send them a link that enables them to join without logging in or setting up new programs. Just tap the link and they’re in the conference. If there’s any issue with using their camera or microphone, we can help with that too.
It’s also important to have patients authorize designees who can listen in and participate in the telehealth sessions. These can be relatives, friends, or professional home health aides. They need not be physically in the same place as the patient, but be present in the sessions and help with any questions the patient may have. The inclusion of someone the patient knows on the calls can be comforting and solve issues faster.
That brings up the next subject – account management. We often find that our patients have difficulty in remembering passwords. And no surprise there! It’s hard to keep track of the many unique passwords we need these days. But, by encoding patient logins in every alert and message we send, the patients don’t need to remember their password to track their vital signs. Otherwise, we might need full-time help just for resetting them. Everything is encrypted for the highest security as well.
Connectivity can be a problem. WiFi is not required but provides a better experience, especially for video telehealth conferences. But some elderly either don’t have WiFi or don’t know their WiFi password. And sometimes cable companies throttle bandwidth so a sudden jump in data transmission may not be well supported. We can provide a cellular-enabled tablet or phone in some cases or just assist with getting connected.
Other remote patient monitoring issues
The remaining issues with getting patients set up and comfortable with technology are common across the software spectrum. Eyesight decline can make it hard to see small text or buttons. High density text or sections can be confusing so pages and views should be simplified. Alerts and warnings should be clear and color-coded. Buttons should be large and have obvious functions.
In summary, though technology can be intimidating to some patients, we have developed software and processes to help overcome their hesitancy. The addition of trained and experienced coaches, technical support, and enrollment specialists, can quickly get this segment comfortably recording their vital signs, taking medications on time, and interacting in telehealth sessions.
With the Delta variant causing a surge in COVID-19 admissions, hospitals are stretched to their limits. Nursing staff and bed availability are at all-time lows and seriously ill patients keep coming into maxed-out Emergency Departments.
The desire to care for patients is ingrained into every healthcare professional so how do they keep caring for patients when they don’t have the bandwidth? RPM can be the solution.
ICU bed shortages for COVID patients
States are reporting a record shortage of available intensive care beds. Some hospitals have been forced to transfer patients to other facilities, possibly hundreds of miles away from their friends and family. Others have had to turn ill patients away and hope that they don’t take a turn for the worse.
Nursing staff shortages
In addition to bed shortages, hospitals are facing historic nursing shortages. With the COVID-19 pandemic well into its second year, many nurses are experiencing burnout and opting to leave the profession. Long hours and the pain of watching patients succumb to the virus have taken a toll. The lack of qualified nurses puts additional strain, however, on hospitals. Even if they have the ICU beds to accommodate patients, they may not have adequate staff to care for them.
How RPM can help
As patients become seriously ill with COVID-19, their first thought is to head to the hospital, where the ED has to make some difficult decisions. If the patient isn’t critical, the staff may be reluctant to give them a valuable bed when someone more critical may follow. However, if they send the patient home and their condition deteriorates, the patient may not realize how severely ill they are until it’s too late.
This is where RPM comes in. Hospitals can send seriously ill – but not critical – patients home with RPM equipment and have them monitor their vital signs. A downward trend in readings can signal to the provider that the patient needs to head back to the ED immediately for admission. Frequent monitoring can alert the provider before a patient would realize their condition has declined.
CW can bridge the COVID care gap
The Community Wellness MyWellness Connect™ app is free for patients to download. Our team can walk them through every step of setting up the devices and tracking their vital signs.
Our Alert & Triage Algorithm kicks in when a reading outside of safe parameters is recorded. The Community Wellness Patient Success team will reach out to the patient and ask them to take another reading. If that reading is also concerning, the provider is notified immediately to review the vital signs and determine appropriate next steps for their patient.
In these unprecedented times, health systems and hospitals need to have every possible resource at their disposal. RPM has become more prevalent and patients are increasingly comfortable with telemedicine now. Let’s embrace the future today when we need it most.
Learn more about our COVID Home Management program.