As areas of rural Nebraska struggle in providing residents emergency medical services, health care and skilled nursing facilities, legislation sponsored by Rep. Adrian Smith, R-Neb., could provide help, especially when it comes to emergency services at nursing homes.
According to Smith and the bipartisan group of lawmakers pushing the Reducing Unnecessary Senior Hospitalizations Act, skilled nursing facilities often are faced with few options to treat residents in need of emergency care.
Smith said that can lead to excessive and costly hospital transfers.
The goal of the RUSH Act is to cross-train existing medical professionals already working at nursing homes and retirement centers to provide needed emergency care through telehealth. Smith said the RUSH Act would offer Medicare recipients better access to care at a lower cost to taxpayers. The bill would fund telehealth services.
Wikipedia defines telehealth as the distribution of health-related services and information via electronic information and telecommunication technologies. It allows long-distance patient and clinician contact, care, advice, reminders, education, intervention, monitoring and remote admissions.
“Right now, Medicare doesn’t reimburse for this on the premise that nursing home patients are very fragile and often have the need to go to the emergency room, but those transfers can be costly and can harm a fragile patient,” Smith said during a visit to Grand Island on Thursday.
He said the bill would reimburse and save dollars, as a nursing home will cross-train a worker into an EMT or paramedic so they would be able to keep the patient at the nursing home. In turn, that cross-trained employee would link up to telemedicine or telehealth with a cooperating hospital, preventing the need for an emergency room or ambulance transfer.
Smith’s legislation comes at a time when nursing homes in rural areas are struggling to stay open.
Recently, the Nebraska Health Care Association announced nursing homes in Columbus, Blue Hill, Milford and Utica are closing. The association said the homes employ a total of 240 workers and have 205 state-licensed beds.
The problem, according to nursing home representatives, is most nursing homes provide care to residents who receive Medicaid, but the state of Nebraska does not pay nursing homes a rate that covers the cost of providing care to residents. During the past two years, Medicaid rates have been reduced by as much as 7.17 percent.
Statewide, 53 percent of nursing home residents rely on Medicaid to pay for their care. In rural care centers, Medicaid pays for as many as 65 percent of the residents.
When it comes to Smith’s bill, according to the Centers for Medicare & Medicaid Services, almost 20 percent of all hospital transfers originate from skilled nursing facilities and 45 percent of them could have been avoided through access to virtual care. According to the Medicare Payment Advisory Commission, rehospitalizations expose seniors to increased risk of falls, delirium, infections and adverse medication interactions.
According to the Center for Connected Health Policy, skilled nursing facilities provide services to a population of predominantly older adults who have limitations in their ability to independently care for themselves due to multiple and co-existing cognitive, physical and chronic conditions. It says “an aging population and a lack of resources for long-term health care are leaving skilled nursing staff increasingly responsible for a growing frail patient population that requires significant medical, therapeutic, and rehabilitation services due to their significant risk for adverse, complicated, and costly health events.”
According to a recent U.S. Census Bureau report, more than 1 in 5 older Americans live in rural areas. Many of those older populations are concentrated in states where more than half of that demographic lives in rural areas.
The Census report said 35 percent of Nebraskans 65 or older live in rural areas, while 65 percent live in urban areas. Of Nebraska’s population of 1.929 million people, 664,330 live in the state’s rural areas.
Smith’s bill would help skilled nursing facilities to equip themselves with trained emergency medical technicians and with the technology to bring the capabilities of an emergency room right to the patient’s bedside.
A 2014 study found that a long-term-care facility that averages 180 hospitalizations a year could reduce that number by at least 15 through telehealth, saving more than $150,000 in Medicare costs.