Electronic Health Reporter

By Waseem Ghannam, MD, MBA, MHSA, president, TeleHealth Solution

Across the country, well over 100,000 Americans are currently hospitalized with COVID-19, and these numbers continue to climb along with rising positivity rates. Similar to the earliest days of the pandemic, this surge in patients is filling hospitals to capacity and beyond.

The resulting shortage of beds and clinicians threatens to compromise quality of patient care and even raise the specter of rationing care in some hard-hit communities.

Increasingly, hospitals are recognizing that telemedicine provides a powerful tool for stretching limited resources by preventing and better managing overcrowding.

Telemedicine can make a critical difference in three key ways:

1. Telemedicine enables rural hospitals to treat patients with complex needs, reducing or eliminating the need for transfers. For critical access hospitals without specialists such as cardiologists or pulmonologists on staff, managing patients with complex or high-risk medical needs – whether COVID-19 related or not – typically requires transferring them to a tertiary facility. By providing virtual access to experienced board-certified specialists as needed, telemedicine allows rural hospitals to diagnose and treat many of these patients right in their own facility.

For example, consider a patient admitted to a rural hospital presenting with elevated biomarker levels. Through telemedicine, a cardiologist can remotely evaluate whether the patient is having a heart attack or displaying COVID-related organ stress. The specialist can then collaborate with on-site care providers to determine if the patient can successfully be cared for internally.

Telemedicine can also play a valuable role in critical access facilities when patients admitted with COVID-19 begin to suffer increased respiratory stress. A pulmonologist can remotely evaluate whether intubation is required. If it is not, the specialist can also help continue to treat the patient safely in place, avoiding the need for transfer.

In addition, telemedicine can provide or supplement hospitalist services, including rounding and admission coverage, for rural hospitals. This capability stretches limited resources and supports local physicians’ ability to provide quality care for all patients in-house.

Clearly, reducing or eliminating the need to transfer patients from rural hospitals frees up space and relieves pressure on providers in tertiary facilities already strained with record caseloads. However, the ability to work remotely with specialists who are experts in managing co-morbidities and complex patient care, offers other benefits as well. Ensuring rural hospitals can access the clinical expertise needed to treat patients in their current and familiar environment avoids the risk, fear, inconvenience and expense of moving patients to another hospital outside their community.

2. Virtually managing patient care in skilled nursing facilities prevents or minimizes need for hospitalization or readmission. Remote on-demand access to physician specialists allows expert management of resident care, whether treating COVID-19 symptoms or evaluating other health concerns such as falls, cardiac issues or chronic disease. Managing care in-house rather than requiring pre-emptive transfer to a local hospital keeps hospital beds open for other patients in need. It also reduces the risk of additional injury or confusion that can occur when SNF patients move to different facility.

 Provisions that expand the use of telehealth are among the waivers that the Centers for Medicare & Medicaid Services (CMS) has put in place during the pandemic. These include waiving the requirement that limited SNF telehealth visits to once a month. As a result, telemedicine has become an even more flexible and valuable option in post-acute care facilities. 

3. Integrating telemedicine is an efficient and realistic step for supporting high quality patient care and improved outcomes in rural hospitals, SNFs and other healthcare facilities with limited resources. Bringing together the right telemedicine staff, technology and training eases pressure on vulnerable rural hospitals already experiencing provider shortages and financial strain, strengthening their ability to keep patients in-house rather than transferring them.

 For example, the Oklahoma State Department of Health has used federal CARES Act funds to initiate a statewide telemedicine network. The goal is to give rural hospitals access to additional expertise and support as they struggle to manage large volumes of COVID-19 patients. As part of this effort, a network of hospitals in rural Oklahoma have begun working with telemedicine provider TeleHealth Solution, through a partnership with Oklahoma State University (OSU) Medicine.

 Selecting the Right Telemedicine Partner

When evaluating potential telemedicine partners, hospitals and SNFs should consider several key factors, including:

• Clinical skill sets. Does the partner offer a comprehensive set of clinical specialty skills, such as cardiology, pulmonology and nephrology, required to meet patient needs? Do these specialists seamlessly coordinate with each other and with local physicians?
• Solution accessibility. Are all services available on a single, simple-to-use platform? Does the solution enable fast, easy access for busy on-site clinicians as well as minimize the need for time-consuming training? Is it a turnkey solution that includes all tools and equipment in the service implementation? Is it flexible, customizable and scalable to support service expansion as needed?
• Partner expertise. Does the partner have expertise in rural hospitals or post-acute health care? How well does the telemedicine provider demonstrate understanding of the challenges and needs of your facility and your community?

As hospitals across the nation continue to grapple with how to maximize resources strained by the ongoing pandemic, integrating telemedicine services can provide a valuable lifeline that substantially reduces overcrowding while also helping to ensure high quality care – wherever patients are treated.