ED-based Models of Telehealth for Older Adults
Tips on setting up the system and delivering the care in the age of COVID-19
May 11, 2020
This webinar has concluded. The recording and webinar materials are available below.
Thank you to all who attended this webinar on May 11, 2020. Below, we have made the webinar recording, chat notes, and presentation slides available for all those interested in learning more about telehealth for older adults during this pandemic and beyond.
Main Learning Points
This webinar assembles four leaders in the world of telehealth to review some essential points of implementing a telehealth programme in your emergency department specifically for the benefit of older patients. Some of the points discussed related to this age of COVID – and most apply at all times.
Dr. Kevin Biese 6’00”
Telehealth is about bringing the expertise to the patient instead of bringing the patient to the expert. In this case this is about providing acute unscheduled care to patients, without necessarily displacing them. This concept is particularly important now when people are, rightly or wrongly, afraid to access EDs and when every displacement and transfer heightens the risk of infection and expends valuable scarce PPE. Telehealth can enhance efficiency, decrease cost, and increase safety and the perception of safety.
Jeffrey Davis 10’40”
The Centre for Medicare and Medicaid Services has, since March 1 2020, implemented some significant changes to what emergency physicians and emergency departments care bill for. Previously telehealth could only be provided in remote or rural areas; now is can be used in any area. Fee codes for emergency management, critical care, and observation can be billed regardless of the place of service – and paid at the same as in-person care. Significant waivers have been implemented regarding HIPAA privacy considerations, including authorizing the use of commercial open access platforms like Face Time, Skype, and Zoom. These changes are established as temporary however getting the “genie back in the bottle” (head of CMS, Seema Verma) may be challenging.
Michael Kurliand 22’30”
Mike describes the development of a programme linking PALTC (nursing homes) in the San Diego County with local emergency departments to avoid unnecessary transfers and hospital utilization. Main learning points from the project: there is suddenly a huge increase in interest in telehealth in the PALTC world; if you’re reaching out to nursing homes, understand their reality — staffing, resident needs, what problems they have and how you can help address them; focus on the communications and the relationships with your local homes.
Dr. Kevin Curtis 38’40”
Kevin describes in detail a hub-and-spoke model of TeleEmergency services where a specialist hospital provides support to many small, critical access, and remote EDs. He reviews some of the main learning points if you want to institute any version of this program; and some of the key components of what he calls “webside manner” – how to ensure that you are providing the same kind of care that you would deliver live.
- To provide an overview of CMS regulation changes allowing for more tele-health utilization and reimbursement during the COVID pandemic.
- To hear from experienced tele-health providers: best clinical tips in effectively diagnosing and treating older adults using tele-health.
- To hear from leaders in emergency medicine tele-health: how to set up systems using tele-health to care for older adults at home, in nursing homes, and in rural hospitals with tele-health.
- To explore models of “forward triage” to safely help older adults receive care in the best location.
Don Melady, MD
Kevin Biese, MD
Emergency Physician, University of North Carolina
Michael Kurliand, RN
Director of Telehealth and Process Improvement
Kevin M. Curtis, MD, MS
Medical Director, Connected Care
Associate Professor of Medicine, Geisel School of Medicine, Dartmouth
Dartmouth-Hitchcock Medical Center
Director, Regulatory Affairs
Dr. Don Melady is an emergency physician at Mount Sinai Hospital in Toronto, Canada and a founding member of the Geriatric Emergency Department Collaborative. He is the author of the website www.geri-EM.com – a CME accredited program for geriatric emergency medicine education – and the chair of the Geriatric EM committee of the International Federation of Emergency Medicine.
Dr. Kevin Biese serves as an Associate Professor of Emergency Medicine (EM) and Internal Medicine, Vice-Chair of Academic Affairs, and Co-Director of the Division of Geriatrics Emergency Medicine at the University of North Carolina (UNC) at Chapel Hill School of Medicine as well as a consultant with West Health. With the support of the John A. Hartford and West Health Foundations, and alongside Dr. Ula Hwang, he serves as Co-PI of the national Geriatric Emergency Department Collaborative. He is grateful to chair the first Board of Governors for the ACEP Geriatric Emergency Department Accreditation Program. His passion is for improved education and systems of care for older adults, and he has published multiple materials in both these areas.