Simione™ Healthcare Consultants

Cost Efficiencies and “The Rise of the Machines”

For those familiar with the second half of this title, it’s the third installment in theTerminator movie series. Mark Tsiames, CPA, CVA, Principal, Simione Healthcare Consultants, notes its high relevance in the home care and hospice industry, when we apply it to the rise of technology in caring for patients.  In particular, telehealth is helping agencies better position themselves as the industry continues to be rattled by Medicare payment reductions for the next number of years.

When Tsiames looks back at his first introduction to telehealth in the mid-1990s at the National Association for Home Care and Hospice (NAHC) conference, he remembers the prototype telehealth unit, which was referred to as HANC (Home Assisted Nursing Care[1]).  “During the demonstration, I was awed by the technology. Today, I smile when we think of that prototype, which was basically a twenty-one inch tube television set mounted on a wheeled cart.  The device reminded me of a first-generation video machine with many wires attached,” Tsiames says.  While the first telehealth unit was almost five feet tall and weighed close to one hundred pounds, it promised to enhance home care with capabilities for capturing video, recording tape, measuring blood pressure, and recording weights.  “We’ve come a long way since that dial-up modem, and transmission of data today is accomplished by units no larger than a mobile phone with capabilities far beyond what we had imagined. From a cost perspective, telehealth brings a wealth of opportunity to explore ways to provide better quality of care in ways that support business performance,” says the certified valuation analyst with 25 years of experience in home care and hospice financial management. 

As we look at the equipment of then and today, the objective remains the same: using technology to better care for patients. This evolution of technology has enabled home care agencies to serve more patients with less staff. For example, let’s look at the rural agency who is trying hard to manage the provision of care over a wide geographic area with a limited number of caregivers. Their ability to attract quality professional staff is limited due to their location along with the expense of a compensation package that would attract the quality staff it needs. “Telehealth presents a win-win proposition for home health and hospice.  When applied after thorough planning, it is typically a good decision both clinically and financially.  This agency implemented a telehealth program, starting with 40 machines, resulting in more patients served by the same number of staff and a reduction in overall home visits to patients,” Tsiames adds.

With continuing payment cuts affecting the industry, Tsiames suggests that agencies look holistically at their organizations, embarking on a thorough review of operations, staffing, technology and finances to fortify their service delivery goals. In understanding how telehealth impacts the home care environment, Simione Healthcare Consultants can help every agency on its journey to embrace “the rise of the machines” in the telehealth world.


[1] Invented by Stephen Kaufman of HealthTech Services in Northbrook, Illinois. The first home based computerized “nurse” to get clearance from the US FDA. It’s an audio-video device aimed at improving outcomes and providing nursing care to organizations with limited access to nursing care.

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