Impact of Telehealth on Hospitalization of Skilled Nursing Facility Patients During the COVID-19 Pandemic

Abstract

Importance:  This very large claims data analysis documents lower rates of hospitalization among patients receiving telehealth during a skilled nursing facility stay compared to patients who did not receive telehealth. These findings from care during the COVID-19 pandemic support the call for telehealth to become a routine option even after the public health emergency has ended. Objective: The COVID-19 Telehealth Impact Study was designed to describe the natural experiment of telehealth adoption during the pandemic.  This focused analysis can assist program development for the large population of patients cared for in skilled nursing facilities.  Design, Setting, Participants: In March 2020, the MITRE Corporation and Mayo Clinic founded the COVID-19 Healthcare Coalition (C19HCC) and Telehealth Impact Study to respond to the pandemic. We report trends using a data set of 668,533 patients cared for in skilled nursing facilities (SNF) between January 2020 and March 2021. Main Outcomes and Measures: We compared rates of hospitalization within 60 days of admission to the skilled nursing facility for patients who received telehealth and those who did not receive telehealth during their SNF stay. We analyzed subgroups of patients based upon the clinical diagnoses for which they received professional services from physicians and other providers. Results: Of the 668,533 patients meeting criteria for an admission to a SNF facility, 97,204 (14.5%) had one or more telehealth visits. 40.1% of patients received one TH visit per 30 days during their SNF stay; 9.4% received ten or more TH visits per 30 days.  Patients in all six diagnostic cohorts experienced significantly lower rates of hospitalization compared to patients who received no telehealth despite having a higher average disease burden measured by the Charlson Comorbidity Index. Absolute rates of hospitalization rates dropped between 1.25% (dementia) and 1.87% (orthopedic) for clinical groups.  The relative rates of hospitalization dropped between 22% (cardiovascular) and 33% (dementia).  Conclusions and Relevance: This study underscores the potential benefits of using virtual care in skilled nursing facilities to lower rates of hospitalization and improve outcomes.  We encourage continued study of the use digital health services for patients in post-acute settings and promotion of insurance coverage in the years to come as new best practices emerge.