Define Success

What problems is the organization facing that telehealth can help fix?  Are you looking to reduce returns to the hospital (RTH)?  Are patients unnecessarily transferred to the ER for a condition that could have been treated in place by a physician?  Are your nurses overwhelmed with staffing shortages?  Are your physicians burnt out?

Recognizing which problem(s) a telehealth program can solve should be one of the first items to consider before incorporating the technology and services into your care processes.  Establishing goals and tactics for a telehealth program should also be included.  For example, if a SNF is experiencing higher return to hospital rates than expected, they should seek a telehealth partner that can be effective in helping them reduce unnecessary transfers to acute care.  Understanding if there are peak periods when patients are being transferred may identify gaps in care where telehealth could be applied.

Once the problem is identified, it should then be decided what the expectations are with a telehealth program in place.  If it is intended to reduce returns to the hospital, goals should be set to determine if the program is successful.  Defining the desired RTH rate and putting reporting in place to track progress are logical next steps.

Operationalize

Once goals and tactics are in place, and a telehealth partner has been selected, it’s time to put the telehealth to work.  In order to do so, workflows need to be established that define when telehealth should be used.  Medical Directors and providers, Administrators, IT Administrators, Directors of Nursing, and educators should all be involved. Processes also need to be in place to guarantee the program is operating efficiently with proper follow-up and reporting in place. Ensuring the technology can be used throughout the SNF is one of the most important operational steps to consider, but oftentimes is an afterthought.  If using iPads, for example, there needs to be consistent wifi access throughout the building.  Putting protocols in place to determine if and when to use telehealth is a critical step.  Also, designating individuals who will be responsible for certain tasks, from educating the nurses on the floor, to following up on physician orders, to tracking RTH, each facet must have someone overseeing to oversee it solidify the program’s success.

Front Line Involvement

For a telehealth program to truly be successful, the front line staff must be involved from the beginning, especially since they are the ones who will be using the telehealth services. Gaining their insights as to which features would be most beneficial (or detrimental) to their work will enhance their buy-in of a program, leading them to utilize the services and help the organization reach is programmatic goals.

Champions in the Building

Appointing at least one champion is another way to create a successful telehealth program.  The champion should be familiar with the program and be available to serve as the go-to for onsite support or an educator for incoming nurses.  This helps maintain consistent utilization well after the initial installation, especially when staffing changes are a “given” in the post-acute world.

Outcomes

Just as it is important for all players to have input and understanding when implementing a telehealth program, it is equally as important for them to know the outcomes of the program, as well.  When everyone understands how telehealth is affecting the organization as a whole, they gain further appreciation and continue to advocate for the telehealth program to be in place.

Proof

One senior living community organization, CarDon & Associates, has adopted a telehealth program in several of its facilities and almost immediately experienced highly favorable outcomes, mainly from applying the tactics mentioned above.  The organization, as a whole, adopted Third Eye Health’s telehealth technology and services.  From executives to Medical Directors to clinical leadership to nurses – all had buy-in of the program from the beginning.

Read about their story, here.

The post Creating a Successful Telehealth Program appeared first on Third Eye Health.

Beyond the Scope of Work

The primary function of Third Eye Health serves to bring access to our board-certified physicians on nights, weekends, and holidays when attending physicians are on call and unable to lay eyes on patients.  Using our secure telehealth technology via an iPad, nurses connect with Third Eye Health physicians in less than two minutes who, on most occasions, treat patients in place without a transfer to the ED and the added risk of an unnecessary readmission.  While treating in place is the core objective when becoming a Third Eye Health facility, there are several additional benefits to appreciate.

Transfer Preparation

While Third Eye Health physicians do have a 90% treat in place record, there are times when our doctors will recommend an acute care transfer due to the circumstances of the consultation.  On such occasions, our physicians may stay online with the nurse through the iPad, assisting in the preparation of the transfer.  If necessary, our physicians can assist the staff nurse with additional orders that could include oxygen, nitro to mentions a few common orders.  Our physicians also can communicate directly with the paramedics when they arrive, relaying pertinent details if needed.

Risk Mitigation

Following each Third Eye Health coverage period, each facility receives a summary of every encounter, alerting the Director of Nursing and the attending physician of any activity that occurred with each patient.  Beyond a simple summary, our Care Coordination Managers, who are all nurses by trade, apply a high level of scrutiny while reviewing each case.  They take the time to look at patient medical history, especially in cases that raise flags of concern.  This is an invaluable service. Our Care Coordination Managers serve as an extra line of defense, providing a second set of eyes for DONs and nurse leaders to review patient encounters and find areas for improvement, for the center, and for the Third Eye Health physicians who are consulting patients.

Case Study: Initiating Plans of Correction

Extension of the Clinical Team

Each Care Coordination Manager works closely with their centers.  Following every Third Eye Health physician encounter, the Care Coordination Manager reviews the progress notes and orders conducting quality analysis checks, ensuring all orders are signed and notes are complete.  Center Directors of Nursing and attending physicians rely heavily on the daily care summaries provided by their Care Coordination Manager to understand the care their patients received while on our watch.  In addition to care summaries, the Care Coordination Manager also establishes a regular metric review, bringing together the center’s clinical leadership time to collaborate on improving care based on the metrics presented.  In some instances, they may review a particular case, or in others the Care Coordination Manager may find reoccurring issues in her metrics that may need to be addressed and work together to establish new protocols that would better serve the patient population.

The post Telehealth: Beyond the Scope of Work appeared first on Third Eye Health.

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.

The post Case Study: Initiating Plans of Correction appeared first on Third Eye Health.

October 6, 2021 (Chicago, IL) – The onset of the pandemic brought a surge in the adoption of telehealth, especially for post-acute operators and provider groups, where patient safety and human capital were of greatest concern. For them, choosing the right telehealth provider with minimal disruption to current workflows was vital to sustaining business. The ideal telehealth provider had to be quick to implement at scale simultaneously across several buildings and have the clinical expertise to care for high acuity patients using secure technology that integrated with their own EHR.  Again and again, Third Eye Health continued to be the leading choice for post-acute operators when deciding on a telehealth provider.

In the early days of the pandemic, Third Eye Health’s footprint grew at exponential rates.  In a matter of months, the organization quadrupled the number of locations it was serving, adding over 550 new buildings and over 65,000 patient beds in the first half of 2020.  This included expansion across the largest national chains. The organization’s vast appeal came from its ability to quick start with easy-to-use mobile, integrated technology (iPads), a large physician practice of board-certified physicians experienced in post-acute care, and a dedicated care coordination service reviewing each encounter for quality assurance.

Having established a strong foundation to support an influx of encounters from both existing and new clients, Third Eye Health continued to be the virtual care leader in the post-acute space, appealing to some of the largest and well-known operators in the country.  In a pandemic year, the organization successfully conducted over 100,000 virtual encounters while maintaining a 90% treat in place national average. Third Eye Health was not only able to prevent unnecessary ER transfers but also alleviate the strain on providers, relieving them of call on nights, weekends, and holidays.

In 2021, the organization’s growth continues.  Although not as quickly as the first months of the pandemic, Third Eye Health has since doubled its client base.  Proven capable of supporting large organizations at scale, Third Eye Health has added some of the country’s most prominent senior living organizations to its list of partners including: CarDon & Associates, Innovative Healthcare Management, Ohio Living, Senior Living Properties, and TLC Management.

“The widespread impact of adding Third Eye’s telehealth technology and physician services extends from our residents to our staff to our providers and local health systems.  Since their implementation, we have experienced improvements in outcomes, return to hospital rates, staff retention, and provider satisfaction,” said Elazar Fischer, Director of Operations for Innovative Healthcare Management.

With over 80,000 encounters to-date in 2021, Third Eye Health is set to outpace its record encounters from last year, all while improving the quality of care provided, treating patients with higher levels of acuity in place at a 92% average.  “It’s been a year of substantial growth for our organization and would not have been possible had the fundamentals of our business not already been in place and functioning well. I really credit our team, who worked tirelessly to quickly get these skilled nursing facilities up and running quickly, expediting care to their patients,” said Dan Herbstman, Co-Founder and Chief Strategy and Product Officer at Third Eye Health.  “While no one predicted a pandemic or the steep adoption rates of telehealth, this past year has opened many new doors for our organization, not only with clients, but in bringing on new services and specialties.”

By having the technology readily available and a team on hand to quickly implement telehealth services, Third Eye Health had room for further innovation, and was also able to offer boutique-level services when special needs arose.  From stabilization visits and extended hours to vacation coverage for providers, Third Eye Health’s skilled nursing partners were also able to adapt to the ever-changing environment that was brought about by the pandemic.  Provider groups and specialists were leveraging Third Eye Health’s secure, integrated mobile technology on their own devices, conducting virtual visits with patients when it was not feasible to conduct a visit face-to-face.

About Third Eye Health

Third Eye Health provides world-class medical care in post-acute care settings, preventing unnecessary trips to the hospital. Through its comprehensive solution, Third Eye Health has developed the nation’s largest post-acute virtual care network consisting of skilled nursing facilities, health systems, providers and payers. Third Eye Health’s proprietary technology, care coordination services, and physician-led night & weekend virtual care delivers immediate access for nurses, enabling bedside patient care. The organization’s esteemed network of board-certified, licensed physicians work with nurses to reduce unnecessary acute transfers and readmissions. Third Eye Health’s comprehensive program improves the quality of care by lowering adverse events and enhancing regulatory compliance. 

Visit ThirdEyeHealth.net to learn more.

###

Media Contact:

Jen Bradley

Senior Marketing Director

Third Eye Health

jbradley@thirdeyehealth.net

The post Top Skilled Nursing Organizations Seek Telehealth at Scale appeared first on Third Eye Health.

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. 

Download case study

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

Our partners and their patients trust that our services and technology always have their best interests at heart.   Keeping patient medical records and passwords secure from attackers is our highest priority.  They only need to get it right once, which means we must get it right every single time.  To do this, we reduce the number of attack surfaces or ways they can penetrate our system.  From our applications to our hardware, everything is safeguarded.

There are two primary criteria for ensuring secure data – 1) it must be encrypted in transit (HTTPS) and 2) it must be encrypted at rest.  Often times a company will claim to “whole disk encrypt” the database claiming encryption at rest.  The problem with this method lies in the possibility of accessibility to the database directly, virtually or physically.  If one exists, it really is not encrypted at rest.  We eliminate this threat by encrypting each record of data individually with its own initialization vector, or unique encryption, eliminating a common key to decrypt all the data. We also don’t store our data on internal servers or internal hard drives.  Everything is kept in a highly secure cloud-based data centers.

When it comes to the iPads used for our telehealth consults with Third Eye Health physicians, similar measures are in place.  Nothing is stored on the iPads, photos are sent to the device as a transmitted image file called a byte array and displayed directly on the screen, so no files are saved on the device. Texts or medical records viewed during the patient consult are gone as soon as it is complete.

Perhaps the best way to understand how we keep patient records and corresponding data secure, is by following the data through the workflow of one of our consultations.  Third Eye Health works with some of the leading EHR providers for post-acute care, PointClickCare and MatrixCare, creating secure integrations with SNF EHRs.  When a nurse is requesting a consult, the integration allows for the nurse to select the patient which loads encrypted data from the EHR directly in our application. During the consultation, any details shared (photos, text conversations) and metrics pertaining to the consult are then securely transferred with encryption to our cloud-based storage, where the data points are encrypted there, as well.

Of course, our workflow does not stop with the end of the consultation. We’ve found that patients experience better outcomes when there are not gaps in care, and so every encounter is reviewed by a Care Coordination Manager in Third Eye Health’s dashboard.  Once again, the dashboard connects with each facility’s EHR in a similar fashion as when accessing and connecting the patient’s name through the iPad by encrypting the data.  It is here where Third Eye Health physicians make notes and submit orders, sending them directly to the EHR. Care Coordination Managers can review this documentation in our system for quality assurance and provide care summaries to the SNF through our secure care coordination messaging platform, even providing links directly to the medical record.

Not all telehealth is created equal when it comes to security.  During the pandemic, some physicians were using Zoom and other unsecure video conferencing platforms to conduct virtual patient visits. Being able to consult with patients in a secure digital environment ensures HIPAA compliance with The Security Rule, preventing unauthorized individuals from accessing health records.  By partnering with Third Eye Health for your telehealth needs you can be certain your patients and their records are safe.

The post Patient Safety in Virtual Care appeared first on Third Eye Health.

Originally, to highlight the compounding issues for post-acute clinicians, this article was meant to have a funny tag line like, “Doctors are People, too,” an attempt to tease out the fact that physicians have regular lives like the rest of us.  An allusion to the idea that in order to be better physicians, they should have the time to tend to those lives – just like when we mortals clock out from work each day.

However, when researching the current literature behind subjects like burnout and the national physician and nursing shortage we are currently experiencing, the topic suddenly became less humorous. Not only is this subject not funny, neither has been our cultural reaction to it – nurses are simply encouraged to work more and physicians operate by day and take call at night.

Booming Issues

Let’s start with the source of our collective challenge: World War II. In our country’s understandable exuberance in the climactic suppression of global fascism, we procreated at an exponential rate, producing that aptly named Baby Boomer generation. That generation now makes up our venerated grandparents and parents who are aging into the post-acute portion of the medical complex in the United States. According to the Association of American Medical Colleges, “The population of individuals 65 years and older is projected to increase by 42.4 percent between 2019 and 2034, outpacing general population growth at 10.6 percent during that period.” Among those 65 year-olds are going to be an accelerating group of retiring physicians, exacerbating the challenge of how we plan to care for this aging population. It is also from this age range of patients we see an ever increasing rate of the diseases which are the leading causes of death in the United States: heart disease, stroke, cancer, diabetes, COPD, and dementia.

This convergence of increasing and decreasing populations (patients vs. clinicians) does rationalize many of our current conversations with Skilled Nursing Facility (SNF) leaders who explain shortages in personnel to cover their daytime clinical needs. With these compounding issues, it is routine for SNF buildings to have a clinician physically present only 3-4 days a week. None have physicians present at night, when many change of condition events occur.

The humor vanishes because the patients involved are our grandparents. They will soon be our parents. Eventually, we all are destined to become patients of an environment in which we are estimated to have a lack of up to 124,000 physicians by 2034. Juxtaposed against this are the recommendations made by Lockley, et al in 2007, in which they published their recommendation in the Joint Commission Journal of Quality and Patient Safety for the United States to strongly consider the establishment and enforcement of safe work-hour limits for clinicians due to the preponderance of evidence linking performance decline to fatigue.

Fighting Fatigue

Our doctors and nurses are tired.

Turns out, Europe agrees, and their agreement predates the Lockley conclusions by 9 years in a law passed in 1998, becoming 100% enforced by 2009. Their policy even has a snappy, yet benevolent title: The European Work-Time Directive. Here is how its policy is applied to physicians. In it are what would be groundbreaking concepts within the United States healthcare apparatus – 11 hours of rest per day, a day off each week, and a requirement on the employer to keep records of hours worked.

And then there is the pandemic. In all the chatter about how businesses are disrupted, schools turned upside down, and so much more white-collar work now getting done in pajamas, did we forget about the most vulnerable among us – the elderly and infirmed? ,It was the nursing homes in this country which bore the brunt of COVID-19, compounding even more issues for post-acute clinicians. They were the most vulnerable prior to the pandemic and they will remain so in the its waning days and beyond if we don’t move to address some of the glaring gaps in care. What should we do for this population at the beginning of what is predicted to be hockey-stick growth? Also, do we have anything to offer the post-acute clinicians who have chosen to dedicate their professional lives, caring for our vulnerable?

Let’s hope so.

Doing Better for Our Clinicians

If not groundbreaking for the post-acute space, perhaps measures such as those from Europe mentioned above would simply be … a relief?  Warranted? Deserved? To the Director of Nursing doing night shift due to lack of staff.  To the contracted nurse practitioner working all day and then manning the pager at night.  To the primary care physician doing the yeoman’s work of driving from building to building in effort to reach all the patients under your care while knowing with the certainty of arithmetic that you can’t reach them all. We have something for you – a pillow.

At Third Eye Health we are a physician practice, focusing exclusively on the post-acute space during periods of time where providers typically take call but should really be sleeping. Our typical coverage hours are 7pm – 7am weekdays and 24/7 on the weekend. What did that EU law say clinicians should have?

11 hours of rest – we provide 12

1 day off per week – we provide 2

Documentation of hours worked – no problem. We provide custom integration with post-acute EHRs, including leaders in this space, PointClickCare and MatrixCare. Everything is documented in your system of record.

As the saying goes, necessity is the mother of all invention…

Relief for Post-Acute Clinicians

When we made the determination to become an exclusively after-hours practice (in so doing becoming Third Eye Health), it was with expressed purpose to create an environment in which post-acute clinicians can sleep through night and have their weekends back – just like every other person in a “typical” job. Afterall, doctors are people, too, right? We leverage our proprietary telemedicine technology to receive calls from SNF nurses, treating patients in place +90% of the time. Our team of board certified physicians do this with an average response time of less than 2 minutes per call. To date, Third Eye Health provides this service to +800 clients, and has fielded +500,000 encounters.

Those who continue in their pursuit of clinical improvement on behalf of the vulnerable are to be praised. However, in the pursuit of the level of care wished for ones own family members, the privilege of sleeping through the night simply should not be on anyone’s list of concerns. There are much larger fish to fry as we all work to bridge the ever-growing gap between the number of patients needing our attention and the clinicians who strive to meet that need.

written by:

Joshua Streit

Director of Growth

Third Eye Health

The post Compounding Issues for Post-Acute Clinicians 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.

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This newly formed partnership makes 24/7 physician access for LTC ACO beneficiaries a reality.

As the nation’s first long-term care Medicare Shared Savings Program, LTC ACO’s success requires an all-hands approach aligning providers, long-term care facilities and health systems to increase value by improving quality and reducing costs.  Partnering with Third Eye Health will have a profound impact on the value created by LTC ACO. With over half a million encounters, Third Eye Health successfully maintains a 90% treat in place rate by providing immediate virtual physician access during nights, after-hours, weekends, and holidays.

EHR integrations and the ability to communicate via video, text, and shared photos, makes thorough physician evaluations possible to when in-person physician visits are not available.  With Third Eye Health, LTC ACO beneficiaries can now be treated in place as soon as a change in condition is noticed, reducing their risk of complications or hospital acquired infections, and ultimately saving the cost of unnecessary readmissions.

An added benefit of this new union lies with skilled nursing facilities qualifying for LTC ACO partnership.  Once implemented with Third Eye Health, the facility’s virtual physician accessibility will be available to all residents, not just the long-term care beneficiaries, and at no additional expense of adopting a telehealth program.

Both LTC ACO and Third Eye Health have admirable track records. In 2019, LTC ACO experienced a 19.6% cost savings rate with a 94.5% quality score resulting in Medicare fee-for-service savings and earning the ACO $18.8 million in shared savings distribution.  The expectation from the inclusion of Third Eye Health’s physician services and telehealth technology is to drive the quality and healthcare efficiencies by keeping beneficiaries in place to receive care.

Ready to bring LTC ACO and Third Eye Health to your long-term care patients? Complete the form below, and a member of our team will be in touch.

Learn more about LTC ACO.

Visit Third Eye Health’s homepage.

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The Difference

Every site with access to Third Eye Health telehealth technology and physician services receives a dedicated Care Coordination Manager, who is fundamental in providing warm hand-offs back to the primary care team following all Third Eye Health encounters.  Every day, Care Coordination Managers, who are nurses by trade, review the details of each consult for quality assurance, looking at notes and orders.  As the primary care team and providers are just beginning their days, they receive a secure, custom care summary from the Care Coordination Manager.

The Care Coordination team reviews all Third Eye Health physician encounters, serving as a second set of eyes and ensuring the proper treatment and care of each beneficiary.  They also recognize areas where protocols and procedures may need to be tightened up and work with post-acute and long-term care leadership to improve those procedures and enhance quality initiatives affecting care 24/7, not just when Third Eye Health is on call.

Much like physician access and telehealth technology, long-term care facilities qualifying for LTC ACO sponsorship will have the added benefit of Third Eye Health’s care coordination services available to all residents, not just LTC ACO beneficiaries.  With these extensions of Third Eye Health in place, it is certain that outcomes will improve for all involved, while returns to the hospital and unnecessary readmissions will diminish.

To understand the full impact Third Eye Health and LTC ACO could have on your center, fill out the form below.  A member of our team will reach out.

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