Canadian Society of Telehealth 04 EVALUATION OF HOME TELEHEALTH SERVICES IN RURAL NORTHERN MAINE: CO

1
Canadian Society of Telehealth 04EVALUATION OF
HOME TELEHEALTH SERVICES IN RURAL NORTHERN MAINE
COST IMPACT OF SAVINGS ON IN-PERSON NURSE VISITS
FOR CHF CLIENTS

• Edwards MA1, Dubois T1, Farren-Tibbetts J1,
  Codrey J2, Berry D2, Carew C1
• 1Sunrise County Home Care Services
• HealthWays/Regional Medical Center at Lubec
• 2Visiting Nurses of Aroostook
• The Aroostook Medical Center

2
Origins of Home Telehealth Project

• Demonstration project to use telehealth to
  increase health care access and reduce delivery
  costs for elders with chronic disease in rural
  northern and eastern Maine
• Funding--1999-2003
• Robert Wood Johnson Foundation
• U.S. Dept. of Commerce, Technologies
  Opportunities Program (TOP)
• U.S. Dept. of Agriculture, Rural Utilities
  Services
• Private Foundations
• Over last 4 years over 5000 telehomecare visits
  have been logged for nearly 150 clients by the
  two agencies

3
 
 
Northeast DownEast Telemedicine Networks
Project included expansion of telemedicine
network into Aroostook County Videoconferencing
aided project implementation, oversight, and case
review among multiple sites of two agencies
Aided successful development of other joint
projects, including an after-hours telephone/
telehealth triage program and a home mental
health care project (Office of Rural Health
Policy)
4
Benefits of Telehealth in Home Care

• Timelier and/or more frequent client assessments
  and monitoring
• Client sense of security in accessing a nurse
  when needed, not just to speak to them
• Fewer clinic, ER, and hospital visits, as
  documented in a few good studies
• Savings on agency transportation costs
  expected--depends on effective substitution of
  some in-person care with telehomecare

5
Home Telehealth Program Elements

• Equipment was ATI Aviva units with BP and
  stethoscope or 8x8 videophone units
• ATI Central Stations located in VNA offices or,
  in laptop versions, in on-call nurse homes
• .

• Placement with client based on diagnosis, need,
  permission of the client, and clients ability to
  use the equipment
• Most common diagnoses were CHF, COPD, cancer

6
(No Transcript)
7
(No Transcript)
8
(No Transcript)
9
Can a Home Health Agency Substitute In-Person
Care with Telehealth Visits? Relevant recent
policy statement A HHA home health agency may
not substitute telehealth services for
Medicare-covered services ordered by a physician.
However, if an HHA has telehealth services
available to its clients, a doctor may take their
availability into account when he or she prepares
a plan of treatment (i.e., may write requirements
for telehealth services into the Plan of
Treatment) (Medicare Manual for Home Health
Care, 2002).
10
Impact of Home Telehealth for CHF Clients on
Frequency of In-Person Visits
11
Home Telecare Effort and Savings on In-Person
Visits for CHF Clients

• Home telecare clients with CHF got .41 fewer
  in-person visits per week than non-telehealth CHF
  clients
• Time to achieve savings of one nurse visit 2.4
  weeks
• This is equivalent to the average 6 telehealth
  visits per month saving nearly 2 in-person visits
  per month per client, i.e. roughly 3 telehealth
  equal 1 in-person visit

12
Costs for Standard Home Health vs. Telehealth
13
(No Transcript)