Telemedicine sounds like a good idea in theory, but how does it actually work in practice? Is its value as great as its promise? The answer is yes. There is a growing body of evidence proving telemedicine’s real value to the hospitals that deploy it—value in terms of quality care, patient health and satisfaction, and the bottom line.
Case in point: One of the nation’s most respected medical institutions, the Mayo Clinic, conducted a study, published in 2017, indicating that doctors assessing comatose patients via telemedicine performed just as well on two common assessment tests as their counterparts at patient bedsides. The study concludes that “telemedicine could be adopted to help evaluate critically ill patients in neurologically underserved areas.”
The study added to the growing body of evidence regarding telemedicine’s value in the ICU. And that’s just one area of the hospital that benefits from telemedicine. It has also been shown to make a real contribution to hospital emergency departments (EDs) and units where non-critical patients are cared for—filling staffing gaps, preventing patient transfers, easing physician overload and providing timely, quality care to patients.
Making Nighttime Care Better, More Affordable
Nighttime coverage has long been a struggle for hospitals, especially now with the growing scarcity of physicians and the growing demand by today’s generation of doctors for more sensible work/life balance than their predecessors had.
Following a series of studies by the American Medical Association and others that documented higher mortality rates for patients admitted after hours, more hospitals in the first decade of the new millennium began stepping up their nighttime coverage by hiring experienced hospitalists—an expensive proposition for any facility, especially those in rural locations that struggled to find enough doctors to meet their daytime staffing needs. Burdening those daytime doctors with rotating night shift responsibilities makes the hiring challenge even greater and adds to the burnout so typical in today’s physician force.
Telemedicine for nighttime coverage—or telenocturnist care—is solving those problems. Industry publications have reported on this fact, including a 2017 feature in mHealth Intelligence that clearly nets out the bottom-line value:
“For many hospitals, a telenocturnist program can strike the right chord financially. Having a real, live doctor on site overnight can run $150 to $175 an hour or more. A telemedicine doctor, meanwhile, can demand $50 to $75 an hour, and that cost is spread out across several hospitals, who pay either a flat rate for access to the service or a per-consult fee.” One healthcare provider (and client of Eagle Telemedicine’s) saved approximately $40,000 a year in staffing costs by using a telenocturnist program.
Money isn’t the only thing hospitals are saving.
“Our telenocturnist services are a cost-effective solution to an expensive staffing problem,” said the chief medical officer for a small hospital in rural Kansas. “Our nighttime doctors were experiencing fatigue and burnout, and we had concerns about nurse turnover and retention, so telemedicine has come at a perfect time as our patient volumes are increasing. With the telenocturnist program, documentation is good, handoffs in the morning are great, and our day hospitalists are very happy with the care our patients get through the night.”
A medical director for a hospital in Richmond, Va., had this to say about the personal value of telemedicine to her and her family. “I have three boys, ages 11, 7, and 5, and I appreciate the regular hours. The telenocturnist program was in place when I started here three years ago, and it is really no different from have a hospitalist working onsite at night. Patients are very receptive to the ‘doc in the box,’ and it makes a world of difference to us. I’ve worked swing shifts and night shifts at other hospitals, and it’s very difficult, especially for physicians with young families.”
Avoiding Transfer of Patients
Because of the growing scarcity of specialist physicians such as cardiologists, neurologists and others, many rural hospitals today must transfer patients to distant tertiary facilities to get the care they need. This poses a hardship on the patient and family when they can’t be cared for in their community hospital. It also means rural hospitals, many of which are struggling financially, are losing money to the big-city hospitals down the road.
For example, what if you transfer a stroke patient because you don’t have quick access to a neurologist to provide the right diagnosis and treatment? A teleneurologist consult in the ED might be reimbursed at a lower rate than what an in-person visit with an onsite neurologist, but keeping the stroke patient in the hospital could mean a $10,000 DRG reimbursement that the rural hospital would lose if the patient had to go to a tertiary facility for treatment.
Telenephrology care is getting lots of attention too, as a means of helping hospitals serve their community better, but also to earn the typical $10,000 in reimbursement revenue when they are able to care for a patient on dialysis (rather than transferring that patient to a distant tertiary hospital). Most hospitals have the equipment necessary for dialysis. Often, it’s gathering dust in a storage room somewhere because there is no nephrologist to manage the treatment program. Telenephrologists can do that … easily and cost effectively.
A Wealth of Other Examples
The examples cited here only tell part of the story of telemedicine’s value to hospitals. There are many more across a range of specialties—psychiatry, infectious disease care, rheumatology, oncology, anywhere a hospital has a need to serve an underserved community. Telemedicine helps hospitals perform better and improve their scores by Leapfrog, the organization that rates hospitals on key areas of performances and posts the grades online.
A recent survey, summarized in a Healthcare Informatics article, showed that more than half of healthcare executives have already implemented telemedicine in their organization, and 24 percent are actively seeding telemedicine solutions. Of those who had not yet adopted telemedicine, 86 percent said it was a medium to high priority. They see how telemedicine is making a difference for hospitals, helping them evolve to meet the challenges of providing healthcare today.