Top 3 insider tips to raise quality while lowering cost
Are you focusing on quality or cost? Don’t choose one—optimize both
with these three insider tips.
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Quality in healthcare has always been the primary focus, but in today’s environment, cost efficiency cannot be overlooked for a moment. Yet with so much of COPD care practices already optimized to streamline spending and drive revenue, what more can providers do? Read on to learn 3 ways to ensure your team is functioning efficiently and effectively
Take full advantage of telehealth and telemonitoring technologies
Advances in Information and Communications Technologies (ICT) such as telehealth and telemonitoring are enabling the delivery of remote, interactive healthcare services to patients and their caregivers. But the benefits go far beyond the operational.
Contributors
Christine Cunningham, RRT
CHI Health at HomeDirector of Clinical Services
Brian Carlin, MD, FCCP, FAARC
Altoona Regional Health SystemPulmonary and Critical Care Physician
Jennifer Anderson, MBA, RRT, AE-C
AU Medical CenterAdministrative Director of Respiratory Care Services and Pulmonary Function Laboratories
Driving the effectiveness of care
Telehealth and telemonitoring, originally intended for patients who lived far from their treatment facilities, is now increasingly being used to improve the treatment and management of chronic diseases like COPD.
In fact, according to the Health Intelligence Network, many of today’s telemedicine programs have been specifically developed for patients with COPD.1 For example:
44%of telehealth-telemedicine programs across all healthcare providers target COPD1
67%of hospital-health system programs include COPD1
Karen Thomas, President of Advanced TeleHealth Solutions, says a properly designed and integrated telehealth program can help you:2
Keep track of symptoms that worsen quickly or unexpectedly
Prompt patients to report the quality of their breathing
Monitor vital signs taken with at-home devices that upload results to an integrated telehealth system
Enable real-time adjustments to treatment
Raise red flags so the care team can contact the patient and caregiver, initiate video consultations, or schedule an office visit
Provide treatment and care directly in patients’ homes, which can be an important benefit for those physically restricted by COPD symptoms
Driving the efficiency of care
Telehealth isn’t just improving the quality of care, but also reducing the cost of it.
In the article, 5 Ways Telemedicine is Reducing the Cost of Healthcare, written by Steff Deschenes for Healthcare Finance News, telemedicine can enable3:
Highly trained professionals to work as a pooled resource
Technology: Remote analysis services, such as telepathology
Patients who would typically be monitored as inpatients to be observed from home
Technology: Remote monitoring
Patients to have televisits with nurses and primary care physicians, to avoid unnecessary and costly ED visits
Technology: At-home triage services
Providers to accept patients based on availability to reduce unused capacity and, in some cases, pass savings on to their patients
Technology: Telemedicine appointments
Care teams to intervene early on, before a crisis occurs
Technology: mHealth monitoring
Information and Communication Technologies will enable us to not only monitor patients, but also apply predictive analytics to alert us earlier when there is a problem.”
Christine Cunningham, RRT
CHI Health at HomeDirector of Clinical Services
TeleMedicine, TeleCare, TeleMonitoring, TelePulmonology, and TeleHealth. What’s the Difference?4
The terms used to describe information and communications technologies are often used interchangeably, but in fact, have different meanings. According to Connect2Health, a task force founded by the Federal Communications Commission, here is how the phrases are defined:
TeleMedicine: Telecommunications technologies to support the delivery of various medical, diagnostic and treatment-related services—usually by physicians.
TeleCare: Technologies that enable patients to stay safe and independent in their own homes.
TeleMonitoring: Technologies that enable providers to capture previously inaccessible in-home patient data, such as vital signs and symptoms.
TelePulmonology: An implementation of telemedicine that could support general practitioners in interpreting spirometry results. In telepulmonology, a GP digitally consults a pulmonologist to gain support in diagnosing patients or to gain treatment advice.5
TeleHealth: Includes a wider variety of remote healthcare services such as health education, social support, and medication adherence typically provided by physicians, nurses, pharmacists or social workers.
Technology enables us to determine patients who
do not require a visit and those who need to be seen right away. This helps ensure better utilization of resources.”
Jennifer Anderson
Administrative Director of Respiratory Care Services and Pulmonary Function Laboratories AU Medical Center
Engage and empower caregivers6
Caregivers—whether full-time or assistive—can play a critical role in decreasing healthcare costs and the need for resources, while maintaining or increasing the quality of COPD care. This can be especially true for chronically ill patients during the post-hospitalization transition, when patients are most vulnerable. According to John Piette, et al., in a paper published in the Journal of Clinical Trial Results, caregivers can help patients: These benefits can help patients maximize the effectiveness of their care plan and maintain wellness to a great extent. Piette reports however, that while assistive caregivers are often an important member of the care team, there may not be a system in place to maximize their abilities.
Maximizing caregiver support
Don’t assume that caregivers are automatically equipped to make a significant difference. You are a key player in transferring information and co-creating plans/programs to help them do their best work. Keep these tactics top of mind:
Co-create clearly defined roles and responsibilities
Inform caregivers by keeping them in the communication loop
Develop education programs specifically for caregivers versus for the patient and caregiver as a dyad
Increasing focus on the needs of the caregiver
Described as ‘potential agents of change that can facilitate and enhance adherence of COPD management behaviors,’ the unmet needs of the caregivers themselves are becoming a focus for some researchers. In fact, according to Morag Farquhar, et al. in a paper published in Chronic Respiratory Disease Healthcare, informal caregivers of patients with COPD have both generic and diseasespecific needs.7 Farquhar goes on to explain that it is rare for clinical and supportive interventions to be made on a patient’s behalf without prior assessment—and that the same should be true for caregivers.
Key considerations when assessing caregiver needs
A Single Assessment Process out of the United Kingdom is said to include 7 key issues to consider when evaluating the needs of the caregiver:7
Extend care team roles and responsibilities
With greater need to drive the return on investimate (ROI) of care delivery, identify ways to drive the ROI of your care team members. One key approach is to extend care team member roles beyond their traditional application. This approach is accelerating in uptake, as was recently confirmed in an article published in Leadership+, a newsletter sponsored by the Healthcare Financial Management Association (HFMA).8 Extending roles helps care teams create more value with their current resources and meet the needs of efficient, effective care. Here are two examples.
Extending the RT role9
According to Timothy Meyers, MBA, RRT-NPS, FAARC, in his article, Thinking Outside the Box: Moving the Respiratory Care Profession Beyond the Hospital Walls, there is a need for respiratory therapists to extend their specialized clinical skills beyond the traditional acute care setting:
Extending the nurse role8
Bobbie Berkowitz, PhD, RN, NEA-BC, FAAN, Dean, Columbia University School of Nursing, says, “The use of advanced practice registered nurses, such as nurse practitioners, can help relieve the shortage of primary care physicians. Utilizing nurse practitioners to the full scope of their license can improve patient outcomes and optimize the healthcare workforce.”
We need to find ways of repositioning the use of
resources from the acute care environment into the home environment.”
Brian Carlin, MD, FCCP, FAARC
Pulmonary and Critical Care Physician Altoona Regional Health System
Meeting the needs of healthcare today
As care teams face greater demand to do more with less, they’ll need to innovate or be left behind. Help your care team deliver efficient, effective care by identifying new ways to leverage telehealth technologies, empowering caregivers, and extending the roles and responsibilities of members of the team.
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Further reading
COPD insider
References 1.2015 Benchmarks Telehealth and Telemedicine. Health Intelligence Network. http://www.hin.com/library/TelehealthAndTelemedicine2015.pdf. Accessed July 1, 2018. 2.Thomas, K. Improvements in COPD Outcomes Through Telehealth. Advanced TeleHealth Solutions. https://www.advanced-telehealth.com/copd-telehealth/. Accessed July 1, 2018. 3.Deschenes S. 5 ways telemedicine is reducing the cost of healthcare. Healthcare Finance News. July 12, 2012. http://www.healthcarefinancenews.com/news/5-ways-telemedicine-reducing-cost-healthcare. Accessed July 1, 2018. 4.Federal Communications Commission. https://www.fcc.gov/general/telehealth-telemedicine-and-telecare-whats-what. Accessed June 2018. 5.Thijssing L.Telepulmonology: Effect on quality and efficiency of care. Respiratory Medicine (2014) 108, 314e318. 6.Piette JD, Striplin D, Marinec N, Chen J, Gregory LA, et al. (2015) Improving Post-Hospitalization Transition Outcomes through Accessible Health Information Technology and Caregiver Support: Protocol for a Randomized Controlled Trial. J Clin Trials 5:240. doi:10.4172/2167-0870.1000240 7.Farquhar M. Assessing carer needs in chronic obstructive pulmonary disease. Chron Respir Dis. 2018 Feb; 15(1): 26–35. Accessed June 20, 2018. Accessed March 15, 2018. 8.Wagner K. Preparing the Healthcare Workforce for Value. Leadership +.May 17, 2017. http://www.hfma.org/Leadership/Archives/2017/March/Preparing_the_Healthcare_Workforce_for_Value/. Accessed July 1, 2018. 9.Myers T., Thinking Outside the Box: Moving the Respiratory Care Profession Beyond the Hospital Walls. Respiratory Care.
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