In this blog series, we’re outlining some of the major hurdles to starting a telemedicine program in the hospital setting. Part I dealt with the failure to see the strategic value of telemedicine, and how to overcome it.
Here are four other strategic hurdles we have encountered in the quest to gain consensus at the medical staff and board level. Resistance comes in many forms—personal, political, institutional—but it can be overcome with a thorough understanding of telemedicine’s myriad benefits.
Overcoming “crisis” planning
Do you have physicians who are nearing retirement age? Physicians who want to start a family? The Joint Commission requires accredited hospitals to have a medical staff development plan, but does yours include a profile of your current staff, their ages, and an understanding of who might be coming “off call” over the next few years? If not, it should.
Telemedicine can help you fill staffing gaps far less expensively than the often-exorbitant rates of locum tenens providers; it’s a sustainable solution compared with the band-aid approach of “fix today’s crisis now.”
We work with a community hospital that has a local cardiologist on-call 15 days a month, and a TeleCardiology team on-call the other 15 days as a “virtual partner”. This is just one real-world example of hospitals finding creative ways to provide a “safety net” should the career plans of local doctors change, as they often do. Telemedicine also helps you implement a staffing schedule that is less stressful on your current clinical team, a schedule that heads off burnout at the pass.
Assessing lack of physician support
In the case of some sole community providers, we see hospitals and medical staffs who evaluate and treat patients with mild complications, but contracted/employed hospitalists choose not to admit the patients. Are the skill sets of certain physicians who are covering certain shifts creating barriers to admission? Are certain physicians just too comfortable in their present “coverage lifestyle” to support keeping more complex patients?
Whatever the case, it’s good to keep in mind that telemedicine solutions—if presented and implemented properly—are overwhelmingly the resolvers of internal staffing conflicts, not the troublemakers. A telemedicine virtual partner might cover the ED or CCU shifts of the reluctant partner with the potential of retaining cases that are currently being transferred. The group, the reluctant physician, and the hospital all win.
From the outset, physicians should understand that scheduled hours of telemedicine coverage don’t have to be a full-coverage-or-nothing proposition. Working with schedules 45 to 60 days in advance often can produce a blend of onsite hospitalists and telemedicine physicians working together in a way that keeps everyone happy.
Overcoming internal resistance
We’ve all witnessed situations in which a key physician or board member initially opposed to an idea turned most of the board against considering it. I’ve seen this with telemedicine adoption, too. It was a case study in what can happen when either “the tyranny of the urgent” or the tendency to “plunge in” caused the internal proponents to overlook key consensus-building steps with the board. They hadn’t worked adequately with board members beforehand to find one or two champions who were receptive to the idea of telemedicine and would help them advance their case.
It’s not as difficult as it seems. In this day of rapidly growing adoption of telemedicine, I haven’t experienced a single scenario where the ED physicians, hospitalists and the impacted specialists were all opposed to telemedicine. Often, if the hospitalists are reluctant, the ED physicians and specialists are supportive, or vice versa. There are usually champions somewhere in your midst!
Addressing value-based care: Fear of performance metrics gaps
Our industry’s transition from volume-based reimbursement to value-based purchasing places a premium on timely care and quality outcomes. Hospitals that experience a decrease in quality below national averages can lose 1.5-2 percent of their Medicare reimbursement if their metrics on certain key performance indicators (KPIs), like average length of stay (LOS) and readmissions within 30 days, fall below certain levels.
In addition to quality metrics, the Hospital Consumer Assessment of Healthcare Providers and Systems, a.k.a. HCAHPS, also has punitive and reward mechanisms for the patient experience. So it is natural to have well-placed concerns about quality outcomes when adding any new providers to your medical staff, including telemedicine providers.
The basis of a sound telemedicine program should be trust. It is best to work hard to build a partnership mindset and avoid “them and us” thinking. In the implementation process, our telemedicine partnership model calls for discussions between local and remote care providers to agree on key clinical workflows, clarity of roles and sharing KPI priorities. This process lays the foundation for clinical communication, builds trust, and often paves the way to discovering and adopting new best practices.
Regarding HCAHPS and the patient experience, we’ve found in our own work that telemedicine consistently raises the bar in both patient satisfaction and nurse satisfaction. Timeliness of care, having the nurse and telemedicine physician team “joined at the hip” by the technology (neither leaves the room early), finding physicians with good camera presence and “webside manner,” and technology with good screen size all seem to be important in making a telemedicine visit a successful one.
Conquering tactical challenges
So now that the powers-that-be have given the green light, what happens next?
In Part III of our series, we’ll look at the tactical challenges hospitals face when implementing a telemedicine program— contractual requirements, staff training, and creating an environment in which staff, patients and families can easily adapt to the telemedicine model. Like the other hurdles we’ve discussed, overcoming them is frequently a matter of being prepared.