Telemedicine is a booming industry. Hundreds of companies are providing virtual physician visits via videoconferencing technology to individuals at home, at school and in the office. A segment of this market consists of companies that provide telemedicine services to hospitals, so patients can get virtual bedside care from physicians and specialists round-the-clock—a big advantage, especially in rural hospitals hit hardest by the physician shortage.
This telemedicine sector is booming, too. How is it working for hospitals?
Very well. Hospitals report they transfer fewer patients to tertiary care facilities because they have ready access to specialized expertise no matter where they are located. Physicians report they have fewer burnout issues because telemedicine doctors can cover night shifts and fill in other staffing gaps. Patients and their families report widespread satisfaction with this new model of inpatient care.
Nevertheless, there are ways to do it wrong and do it right. When a hospital or health system decides to consider telemedicine, the selection process can be a complicated one. Whether you’re dissatisfied with a current provider and considering a change or looking to start a new telemedicine program from scratch, here are three things to look for to be sure you get the telemedicine partner that is right for you.
Determine how care is delivered by telemedicine physicians.
Some telemedicine companies might have dozens of physicians on call across the country to serve the range of their hospital customers. The problem isn’t that they are well qualified. They probably are. The problem is that patients in those hospitals might never see the same telemedicine physician twice during their stay. How does that work?
Nurses have told us that when telemedicine companies furnish “a different doctor a day” or “a different doctor for every call,” it makes it difficult to build a long-term relationship, get to know them and drive better patient care forward. Nurses are an invaluable cog in the wheel of any hospital inpatient program. It’s best to listen to them.
Look for companies that assign a small team or “pod” of six to eight virtual physicians exclusively credentialed for a particular site. Over time, they all become an integral part of a hospital’s clinical team, deeply familiar with a hospital’s specific services, its procedures and its people. The result is more consistent, more personalized care.
This smaller team helps speed the credentialing process, easing the administrative burden for hospitals wanting to start a telemedicine program. It can be a headache credentialing a roster of physicians who might only have a few sessions with patients at the hospital. There’s little return on investment there.
Eagle Telemedicine has begun a telehospitalist/telenocturnist program at Jersey Community Hospital (JCH) in Jerseyville, Ill. The rural hospital about an hour north of St. Louis now joins the more than 150 hospitals nationwide that use Eagle’s TeleHospitalist and TeleSpecialty services.
“We are pleased to welcome JCH to the Eagle family,” said Talbot “Mac” McCormick, MD, president and CEO of Eagle Telemedicine. “JCH was at a turning point, the kind of thing a lot of hospitals face today. When the private physicians were in their offices seeing patients and a full load of work in front of them, calls from the hospital encountered constant interruption, delays, and disconnect in communication. JCH took a bold step to do something different.”
JCH had faced challenges like those of many rural hospitals. Licensed for under 50 beds, it was unable to sustain a full-time onsite hospitalist program and was putting too great a strain on local physicians to share rounding and emergency calls, especially at night and on weekends. Patient retention was suffering. When its part-time hospitalist announced plans to begin semi-retirement, the hospital’s leadership knew it had to try a different approach, something that was a long-term solution.
NPs and Telehospitalists Work Collaboratively
Now with Eagle, JCH has implemented a model where onsite nurse practitioners (NPs) work collaboratively with Eagle telemedicine physicians, who provide support and guidance whenever they are needed.
“We have NPs who are the boots-on-the-ground on the medical floor,” said Michael McNear, M.D., JCH’s chief medical officer. “They are here seven days a week and are the touchpoint with the Eagle telephysicians.” Now the facility is no longer struggling to compete for physicians with larger hospitals in St. Louis and has greatly eased the burden on primary care physicians practicing in Jerseyville.
Most of the physicians on the Eagle team are in Kansas and are part of a Great Plains consortium founded to help rural hospitals in critical access areas solve staffing challenges.
Patient Transfers Already Reduced
Though it’s too early to have metrics showing the positive contribution of the Eagle program—it went live May 13—Dr. McNear says it’s clear the program has reduced the number of patients JCH was transferring to other hospitals.
“We had seen a general movement of more patients being transferred from our Emergency Room (ER) to other hospitals for several reasons, including the fact that our physicians just weren’t comfortable caring for a higher level of patients. With Eagle’s telemedicine physicians handling our admissions and our coverage, we have eliminated that. They are very experienced and comfortable with hospital medicine and caring for critically ill patients.”
Patients and staff have adapted well to the new program, according to Julie Smith, RN, JCH’s chief nursing officer. “After the announcement of the program at JCH, we had a lot of questions about rolling a computer robot into patient rooms,” she said. “But when the telemedicine physicians appeared on the monitor and talked with us, everyone was really impressed. When we finally went live, the patients were easily happy with the situation. There weren’t any naysayers left after the first week.”
Erin Kochan, population health director for JCH, had worked with Eagle at her previous position at HSHS St. Elizabeth’s Hospital in O’Fallon, Ill., which has a TeleStroke/TeleNeurology program managed by Eagle. She helped JCH make the initial connection with Eagle.
“Fifteen years ago, before I got into administration, I probably would have said that telemedicine will never work,” said Dr. McNear. “But over the last 10 years, you start to see the bigger picture. These kinds of programs absolutely can work. The main thing the patient wants is to be treated well and be listened to. Wherever that comes from, they’re going to be happy.”
Telemedicine has already proven its effectiveness in traditional acute care hospitals, providing consistent coverage in areas where physicians are hard to come by, guiding clinical teams and leading specialty programs. Now telemedicine is making inroads into a new model of care—micro-hospitals. The growth of micro-hospitals, where small neighborhood hospitals offer care tailored to the specific needs of a community, is dramatic—and telemedicine is helping drive it.
Communities in 19 states have micro-hospitals today, and the numbers are climbing. Cited as a new trend in healthcare by U.S. News & World Report, micro-hospitals typically have eight to 10 short-stay beds and a small ED. They can provide the imaging and lab services performed in larger hospitals, but they are geared toward moderately ill patients who don’t require the intensive care and longer stays required by patients in traditional hospitals.
Because of this patient profile, micro-hospitals can hire fewer physicians—a plus given today’s physician shortage—and can rely more heavily on nurse practitioners (NPs) and physician assistants (PAs)—whose numbers are growing—to assume key leadership roles, make daily rounds and provide hands-on coverage.
A Perfect Environment for Telemedicine
Telemedicine teams offer a cost-effective way to provide on-the-spot, expert guidance to NPs and PAs via web videoconferencing, telephone and secure texting. One could argue that the emergence and growing public acceptance of telemedicine has made the physician-lean, micro-hospital model possible, helping bring cheaper, faster care to moderately ill patients. To illustrate, one company we are working with plans to place 70 micro-hospitals across the country over the next four to five years, and telemedicine will play a key role in all of them.
A Range of Specialized Care
In micro-hospitals, telemedicine serves a function that is similar to the model for many critical access hospitals, where NPs manage hands-on coverage of patients with guidance from telemedicine teams. A videoconferencing cart or “robot” delivers expert physicians to patient bedsides, where the physicians can converse with staff and patients. With the help of the onsite nursing team, they can access diagnostic equipment on the cart to examine patients and make a diagnosis. The telemedicine physicians also work with ED physicians to admit patients, examine them once they have a bed, and develop a plan of care to be carried out by NPs and nursing staff.
The telemedicine physicians might be in the same state and time zone; they might be across the country or, in some instances, halfway around the world, but they must be licensed in the state and credentialed by the hospital in which they are practicing. If they see that a specialist’s care is called for, they can contact a team of specialists—cardiologists or neurologists, for example—who are under contract to examine the patient via telemedicine and provide a diagnosis and treatment.
Given the growing shortage of specialists in the United States—the Association of American Medical Colleges (AAMC) projects a deficit of up to 61,800 specialist physicians by 2030—being able to contact a remote team immediately via telemedicine is another plus for micro-hospitals. For example, teleneurology specialists typically achieve an average response time of 3.5 minutes (a fraction of the time it typically takes for a local neurologist to get in the car and drive to the hospital), and an average diagnosis and treatment time of 21.8 minutes.