Telemedicine is a rewarding field to be in for many reasons. We make healthcare easier to access for patients and their families. We’re saving doctors from burnout. We help hospitals find a sustainable solution to complex challenges. It’s extremely gratifying to be part of an industry that does so much good.
Take, for example, the recent upsurge in the number of rural county hospital leaders who raise legitimate concerns about patient transfers and don’t know how to stop the outflow, or “outmigration” as we’ve heard it referred to. Though we have helped many hospitals solve this problem over the years, a rising tide of hospitals has come to us recently with the same problem—only this time with more urgency. Calls come in frequently, and the question is always the same: “Can you help us?”
Reaching a tipping point
We have had many conversations on the topic with physicians and hospital executives attending recent industry gatherings, like this spring’s annual conferences of the American Telemedicine Association (ATA) and the Texas Organization of Rural and Community Hospitals (TORCH). I won’t say the industry is in crisis mode yet, but we are reaching a tipping point. For some rural hospitals, the number of patients they transfer is higher than the number they admit.
To solve the problem, it’s important first to understand what’s causing it.
Sure, the physician shortage―particularly the growing scarcity of specialists―plays a major role. Rural hospitals don’t have enough local specialists available when they need a consult with a patient needing focused attention from a cardiologist, neurologist, pulmonologist, or other specialist. But there are deeper shifts within the industry that lie at the heart of the outmigration situation. The first has to do with the sheer range of technology-enabled hospital treatments available to patients today. The second has to do with the way young doctors are trained.
Hospital medicine has grown more sophisticated
Hospital medicine has evolved so quickly over the past few decades that the scope of what primary care physicians do is only a small part of what goes on in healthcare today. When my dad was a family practice physician in a small New Mexico town 30+ years ago, he did just about everything his patients needed. There wasn’t much difference between the care he provided and the care his patients would receive at far-away tertiary hospitals.
Today, those far-away tertiary hospitals have evolved into centers of excellence that are performing incredibly sophisticated, high-intensity procedures—blood-clot retrieval for stroke patients, for example. Such procedures, along with the expertise to perform them and the equipment and technology to support them, are beyond the realm of what a typical community hospital can ever be expected to provide.
That doesn’t mean that rural hospitals have no place in healthcare today. To the contrary, there are essential functions rural hospitals can and should be performing—functions that don’t require state-of-the-art surgical equipment. In the example of the stroke patient, for instance, patients who have a transient ischemic attack (TIA)―or “mini-stroke” as it is sometimes called—could stay at their local hospital for secondary stroke prevention or rehabilitation.
Yet in many small hospitals, every single one of those patients goes to a larger facility up the road. Why?
Today’s medical culture: A smaller margin of comfort
Most physicians today are trained in academic institutions with a breadth of specialties at their beck and call. When physicians leave school and go out on their own, either to establish a practice or work as part of a hospital clinical team, they understandably feel less comfortable working with specialty care patients when they don’t easily have a specialist within reach.
Given their background, there is a tendency to “err on the side of caution” and send the patient to a tertiary care center. It’s sometimes referred to as “seeing and shipping,” and it’s not always in the best interests of the patient or the hospital.
Indeed, both hospitals in this scenario—the rural facility and the tertiary one—suffer as a result. The rural hospital reduces its census, and the tertiary care center ends up with a patient it is not designed to care for. These centers are equipped with investments in some of the world’s costliest and most advanced medical equipment to treat patients with the most challenging conditions; they don’t like to see their beds filled with patients who require more conservative care that could easily have been managed in a community hospital.
Transfers cut in half with telemedicine
Telemedicine offers a real solution. By providing quick access to specialists via two-way videoconferencing, secure texts and phone calls, telemedicine can give young physicians—and all clinical staff, for that matter—the specialist back-up they need to manage care and transfer fewer patients.
One of the best recent success stories is a rural Kentucky hospital that was transferring 10 neurological patients a month to a university neuroscience center. Once the hospital became an Eagle partner and was able to access our acute stroke consultation team via our teleneurology program, the number of monthly neurological transfers dropped to five.
We see similar results with other specialty telemedicine programs: TeleCardiology, for example, where ST-Elevation Myocardial Infarction (STEMI) patients are transferred to tertiary centers for stent placements, open-heart surgery, catheterizations, or other complicated procedures, while patients with less catastrophic problems, such as congestive heart failure or atrial fibrillation, are managed in the local hospital by hospitalists and a cardiac specialist available for a virtual consultation.
These recent successes underscore for us at Eagle how telemedicine is taking its rightful place in the evolution of healthcare today. “Hospital culture is shifting toward telehealth,” states the headline of a May 3 Healthcare IT News story on a panel discussion at the ATA conference. We’re doing our best to make the shift happen for more and more rural hospitals who, as we’re learning, don’t have time to wait.