A Third Eye Health Care Coordination Manager, conducting the daily report, came across an encounter for a change in condition noting skin discoloration, signaling an end of life.  Eventually, the patient did pass away.  Upon further review, looking at past medical records for the patient, the Care Coordination Manager uncovered several concerns involving this case that, if reviewed by the Department of Health, could be seen as a deficient practice by the center.

Challenge:

Looking back at the deceased patient’s medical records, the Care Coordination Manager noticed that the patient had a central line.  Further analysis revealed that there were no orders for the care, treatment, or flushing of the central line, though.  Additionally, a redness, possibly indicating an early-stage infective process, had been noted but with no mention of a doctor being notified. Whether protocols were not in place or not being followed for patients with a central line, this is an issue that would raise red flags should the Department of Health review this particular case.

Solution:

The Third Eye Health Care Coordination Manager presented the facts of the case to the center’s Director of Nursing and Regional Medical Director during a routine metric review.  Noting that it had the potential to be flagged by the Department of Health for several issues, this became a teaching moment for the center.  By catching the issues ahead of any audits from the state, they were able create and execute a plan of correction around central line protocols and several other issues identified by the Care Coordination Manager.

Benefit:

Taking the time to review a patient’s complete medical history, while ideal, is a rarity for a Director of Nursing with no shortage of tasks on their plate. Unfortunately, under most circumstances, it is the state that ends up finding these errors in care. By meticulously reviewing this patient’s record, the Third Eye Health Care Coordination Manager was able to bring forward several issues to the center’s clinical leadership, pinpointing areas that would cause alarm for any audits the state might conduct.  While the patient’s death itself was not unusual, by looking back through the complete medical record, areas where protocols were not in place or applied were now identified.  With this information, the center proactively expedited a plan of correction, training its nurses and setting processes in place to prevent future reoccurrences.  This will be especially beneficial should the Department of Health review this case, they will see that the building took the initiative to improve the quality of care they are providing.

Result:

By immediately creating this correction plan, showing that they have educated the nurses, and that the changes have been put to action ensuring such an event will never occur again, the center is now prepared when the Department of Health arrives.  Upon investigation of the deaths, the Director of Nursing will be fully equipped with a well-documented plan of correction, showing what measures have already been put in place to ensure quality improvements and prevention of reoccurrence. By showing diligence in recognizing the issue and already initiating a plan of correction and future prevention, the center may receive a tag for this case, but will be able to prevent an even more severe punishment such as being put in jeopardy by pausing new admissions, inflicting punitive financial damages, and declining CMS star ratings and reimbursements.

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ITEX is the family-owned operator of Glenview Terrace, Harmony and Whitehall of Deerfield. They are the market leader for post-acute rehab in the Chicago area. They are also in the preferred provider networks for some of the largest health systems in Illinois (Advocate Aurora Health, NorthShore University HealthSystem, and Northwestern Medicine). Third Eye Health’s telehealth solution has supported both ITEX and its network of skilled care centers in keeping patients in the same health system and avoiding leakage. 

Pre-Third Eye Health Challenges 

Known for delivering exceptional care in Chicago and throughout the North Shore, ITEX sought to improve the availability of providers during nights, weekends, and holidays. Their skilled nursing facilities were affiliated with a large clinically integrated network in Chicago and were finding it difficult to treat ITEX’s residents across a large geographic area. This was especially true as the 2020 pandemic set in and human resources became even more scarce. As a result, newly presenting changes in condition during periods when providers were on call on nights, weekends, and holidays, often led to either delays in care or patients being transferred to the ER, subsequently leading to unnecessary readmissions. 

Timeliness to care is essential in matters of patient satisfaction, clinical outcomes, and minimizing the cost of care. In most scenarios, these readmissions were preventable had a provider been able to properly assess the patient and treat them in place. ITEX understood that while their care was highly regarded, there were still opportunities for improvement when it came to ensuring their residents receive the highest level of care possible. 

With unnecessary readmissions being a significant driver in rising healthcare costs, the provider group collaborated with ITEX, seeking a solution to reduce these unnecessary readmissions and their associated costs. After-hours readmissions were on the rise with providers spread thin in their on-call capabilities. And without virtual access to the EHR, there was a lag in documentation and orders being signed, leading to further delays in care, worsening conditions, and transfers to the ER. Oftentimes transfers became readmissions that could have been prevented had a provider been able to treat the patient in place. Ian Crook, Chief Operating Officer for ITEX remarked, “Adopting a system-wide telehealth solution with the support of our providers was key to the success we experienced in increasing the quality of care for our residents.” Having used their services in other local SNFs throughout Chicago, the provider group was familiar with the impact of a well-known post-acute telehealth provider, Third Eye Health, and recommended ITEX consider adding their services for night, weekend, and holiday provider coverage. 

Why Third Eye Health? 

Many of the providers for the ITEX had already been familiar with Third Eye Health, the nation’s leading virtual care provider for post-acute, and had seen first-hand the benefits to patients, providers, and entire health systems when their services and technology were in play. One of the greatest observed benefits to providers being that high-acuity patients had access to quality care at all times of the day with Third Eye Health’s board-certified physicians taking call on nights, weekends, and holidays. 

Through their telehealth technology, a Third Eye Health physician can be available to consult with the bedside nurse and resident within minutes. EHR-integration capabilities give Third Eye Health physicians visibility to patient medical records and the ability to add notes and signed orders. Secure video, text, and image sharing capabilities enable the Third Eye Health physicians to lay eyes on the patient, have in-depth conversations with both nurse and patient, assess lab reports and additional paperwork all with the use of a simple app on an iPad. Additionally, with Third Eye Health’s Care Coordination services, documentation of every Third Eye Health encounter is reviewed and summarized, then shared with the primary provider and nurse leaders, creating a warm hand-off in care before the next day begins. 

For the provider group, bringing on Third Eye Health meant offering relief to their providers on nights, weekends, and holidays. In many instances, Third Eye Health physicians can respond faster and provide a much more thorough assessment using the secure, integrated technology than a provider could over the phone. Patients can receive high quality care from board certified physicians without being transferred to the ED. And by treating them in place, patients do not risk exposure to additional infections, worsening conditions, or the possibility of being moved to an entirely different facility following discharge. They remain in the same care and Third Eye Health’s Care Coordination Managers ensure that a full summary is provided after every encounter. 

Another factor making Third Eye Health the ideal candidate to support ITEX’s clinical team in caring for residents was its ability to integrate with ITEX’s EHR, PointClickCare. Third Eye Health is unique in that all their technology is developed in-house. And so, by aligning with EHR’s, such as PointClickCare and MatrixCare, Third Eye Health is quickly and easily able to implement their services which facilitate bi-directional EHR-integration, enabling access to medical records for ITEX’s clinical team from Third Eye Health physicians and vice versa. 

Implementation

ITEX saw many advantages in bringing on Third Eye Health as their virtual care provider. The implementation process was highly efficient and quick. In a matter of weeks every center was up and running. Several factors contributed to the quick-start capabilities of Third Eye Health. 

“Third Eye Health’s technology and physician services fit within our pre-existing workflow, making it easy for our clinical teams to initiate virtual care consultations,” said Crook.

As already mentioned, Third Eye Health has an in-house development team and a pre-existing partnership with PointClickCare, expediting the EHR-integration into Third Eye Health’s proprietary telehealth technology. Next, Third Eye Health uses iPads to conduct their virtual bedside visits. Whereas most telehealth solutions use third-party carts, iPads are easily accessible and incredibly mobile, making it easy to travel from room to room with the nurses as they conduct their rounds. And since most nurses are familiar with using iPads, the technology was easy to learn. Third Eye Health works directly with the nurses and leadership in each center and offers training by experienced post-acute nurses. With iPads in hand, nurses could confidently begin consultations with Third Eye Health that same day. 

The technology on the iPad is simple to use. With the tap of a button, nurses saw for themselves that they could connect with a physician within minutes. They could text, share photos, and video chat with physicians. And with the PointClickCare integration, all notes and orders were readily available in the EHR following each encounter. 

Each center has a dedicated Third Eye Health Care Coordination Manager whose day begins at the end of day-shift by receiving a report from the center informing Third Eye Health of high risk patients, new admissions or any pertinent information the Third Eye Health physicians may need should they be called. Bringing the care full-circle, the Care Coordination Manager reviews each encounter and sends a summary immediately following a coverage period ensuring proper attention continues once the primary provider returns the next day. 

Impact

Once implemented, utilization of Third Eye Health’s services created an immense impact on ITEX patients, providers, and clinical staff. 

For patients, they could be seen by physicians with access to their medical records at any time, day or night. They were being treated in place, often preventing further complications to their condition and better clinical outcomes. As patients were able to see a physician when needed, patient satisfaction levels rose even higher. 

Nurses had access to Third Eye Health physicians through easy-to-use mobile technology. They were no longer waiting for physicians to call back, or for orders to be signed. Third Eye Health physicians answered consultation requests, on average, in under two minutes. Physician notes and orders were available directly through their EHR. Administrators and Directors of Nursing benefited from the quality assurance of the Care Coordination Manager reviewing each encounter and from the detailed analytical reports made available through Third Eye Health’s technology. For them, there was an extra set of eyes looking out for regulatory matters and reducing risk. 

For ITEX, more patients being treated in place meant that fewer patients were returning to the hospital. More beds were full and the amount of mandatory bed holds decreased. Less transfers to the ER meant fewer unnecessary readmissions, and a lower probability of patients being discharged elsewhere. And as clinical outcomes improved, they were regarded highly by local health systems in their ability to provide high quality care, deeming them a leading partner for post-acute care. 

The provider groups serving ITEX also experienced a higher level of satisfaction by no longer taking calls. They were able to take much needed time to focus on their own health and well-being, and in turn, found themselves able to perform better at the bedside. Their Medical Director (who had been with ITEX for over 30 years) valued these benefits and used them as a large recruiting tool for the provider group, promising nights, weekends and holidays off – an anomaly when it comes to post-acute medicine.

From Ian Crook’s perspective, “Physician satisfaction rose once Third Eye Health began covering nights and weekends for multiple reasons. Fewer residents returning to the hospital sustained care continuity within our communities, dispelling leakage back into the health system. In finally having an opportunity to rest, interactions between providers and nurses improved, positively impacting the overarching quality of care for our residents. Most importantly, our providers had peace of mind knowing their patients have access to a dedicated group of physicians watching over their care on nights, weekends, and holidays.”

Lifetime Impact 

4384 Consults

95% Treat In Place Rate

Treat in Place by Encounter Type

100% Treat in Place Rate for TOP 10 encounter types

The exception: high acuity conditions that should warrant a transfer to the ED in many cases, such as: 

• Fall with Injury: 84% 
• Hypoxia: 59% 
• Chest Pain: 65% 

Summary

It’s not surprising that Third Eye Health continues to be the leader in virtual care in the post-acute world. Their technology is easy to implement and even easier to use. With PointClickCare and MatrixCare integration and dedicated care coordination, all the guesswork is eliminated, supporting the primary clinical team through seamless transitions in care. 

The quality of care received from Third Eye Health physicians complements that of the primary providers. By treating patients in place, clinical outcomes and quality measures improve. 

What sets Third Eye Health above any other post-acute telehealth provider is its ability to provide integration at scale, essentially becoming a force multiplier in delivering high quality post-acute care: as care quality increases, so do outcomes, patient satisfaction, staff and provider satisfaction, as well, all while reducing the overall cost of care. 

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The post How ITEX improved resident outcomes with integrated virtual care appeared first on Third Eye Health.

This case study demonstrates how the existing partnership between Third Eye Health and MatrixCare paves the way for integrated care.  CarDon, a Midwest-based post-acute operator, recently sought out Third Eye Health to provide physician consultations to residents in their senior living communities over nights, weekends and holidays.  In addition to providing immediate physician access, improving quality measures, and reducing medical costs, a large factor that led CarDon to choose Third Eye Health was its existing partnership with MatrixCare and its ability to provide secure, integrated telehealth in real time. 

CarDon needed a solution that could positively impact return to hospital (RTH) rates by treating patients in place.  Once learning that the their EHR provider, MatrixCare, had an existing partnership with Third Eye Health, the decision in choosing a telehealth provider was easy.  Through secure integration, both the providers and nurses at CarDon and the Third Eye Health physicians have real-time access to patient records.  This is especially important as the quality of resident care relies deeply on accurate data.

“It really takes the work off of our staff, especially having the documents import directly into the resident documents section with the physician signature. We don’t have to wait days for these notes; they’re already in there.”

– Brandy Armstrong, Director of Clinical Information at CarDon & Associates

The first six months of service by Third Eye Health resulted in an 88% average treat-in-place rate across over a dozen skilled nursing facilities, an improvement from the previous quarters, leading to fewer RTH and avoidable readmissions. Physician satisfaction has also improved, as primary providers are able to get some much needed rest by trusting the Third Eye Health physicians in the care of their patients, mirroring their own protocols.  Quality measures are improving, as well, including RTH reductions and clinical outcome improvements, all stemming from immediate physician access.  Warm hand-offs from Third Eye Health physicians to CarDon’s primary providers and nurse leaders through Third Eye Health’s Care Coordination daily summary reports ensure that patients continue receiving high quality care around the clock.

The post Case Study: Integrated Telehealth with MatrixCare & CarDon appeared first on Third Eye Health.