Telehealth’s Potential to Increase Medicaid Rates

Skilled nursing facilities across America, especially rural facilities, are challenged by chronic underfunding and reimbursements shortfalls, with centers caring for high Medicaid populations at the greatest risk. Medicaid simply doesn’t pay the true cost of care provided by the facility to the patient.

As a result, many nursing facilities lose money, when adjusted for inflation, or return margins so low that they cannot invest in necessary capital improvements or advanced technology that would enhance care. Some facilities may even turn away seniors on Medicaid because they cannot afford their care, which creates access to care issues.

Tapestry Telehealth is changing the equation.

A rural nursing home in Maine that partners with Tapestry Telehealth just finished a study on our TapestryCare™ platform’s impact on its case mix index (CMI). What they found was impressive. By using TapestryCare™, they increased their average Medicaid rate by $22 per day, year over year, adding $400,000 in revenue per year.

State experiences may differ, but there are a number of things that TapestryCare™ does (and documents) in the course of regular business that should be captured by the MDS (Minimum Data Set) nurse who conducts the federally mandated assessments of the patients at your long-term health care facility to help drive up your reimbursement.

Some examples:

  • Overall increased visits: These are typically long-term care residents who may have not been seen much. Long-term care patients (not short-term stay patients) have to be seen by a doctor once every 60 days. Unless something big happens, they just don’t get seen by a doctor very often. TapestryCare™ makes it easier to care for them routinely and regularly at their bedside. Capturing the visits and resulting orders and interventions can help the CMI.

  • Change in condition: Referring any changes in condition or clinical issues to the Tapestry nurse practitioner (NP) may result in an opportunity to capture increased acuity (e.g respiratory infections with a fever).

  • Clinical interventions: If the NP is ordering interventions like IV fluids or medications, oftentimes they can be captured for acuity. It’s especially important to do them in-house rather than at the hospital.

  • Properly staging and documenting ulcers. Get us involved and we can help.

  • New orders and changes: Again, these may affect CMI if captured and reported properly.

The reality is that TapestryCare™ ensures you get credit for what you are already doing, and that’s delivering care to the patients and residents in your facility. The results seen at the Maine facility correlated with high TapestryCare™ utilization, which is essential to the success of the program.

The challenges facing long-term care providers, especially rural nursing homes, are enormous. But there are opportunities as well, and TapestryCare™ is proving itself not just in improving clinical outcomes, but financial outcomes as well.