Telemedicine Program Signals Bold Leadership on a Small Scale

Stop me if you've heard this before: Hospitals have to embrace a new era of accountability. They need to be bold leaders in changing our sick care system into a true healthcare system.

I could go on and on, but I sense you tuning me out already, because that's what everyone tells you your organization must do. These infuriatingly broad platitudes attempt to make simple the massive changes facing you and your team.

It's far from simple.

Sure, it's easy for consultants and column-writers to tell you that you need to think innovatively, that you have to treat patients as customers, and on and on.  They (we) don't have to do the work.

But maybe the task of transforming isn't accomplished in big, far-reaching initiatives, necessarily. They are nice, and they have their place, but innovations don't always have to be revolutionary.

If you've been reading HealthLeaders' analysis over the years, you know we focus on how to help you lead your hospital better. It's not because we necessarily know how to do it, but because the best of your peers in the industry do, and are willing to share.

Let me tell you a story about a large hospital system in New York that is doing something pretty simple and low-risk, but could offer potentially big returns down the road.

Beginning last month, Continuum Health Partners, a partnership of three hospitals that includes the flagship Beth Israel Medical Center, started offering 24/7 access to its physicians through Teladoc, a subscription service targeted toward New York City residents for consultation on minor medical conditions.

They see the service as a way to broaden access and to serve as an alternative to ER visits or for when patients are unable to get in to see their physician in person.  Spoiler alert: I know what you're thinking, but Continuum physicians did not show up at Harris Nagler's doorstep with pitchforks and torches.

In fact, they welcomed the move. Why? It's a new revenue stream, for starters.

Nagler, Beth Israel's president, and an MD himself, says Teladoc is not a competitor for Continuum's physicians. Actually, they'll take many of the calls or video consultations. The service is a variation on the concierge healthcare trend that until now, has been slow to pick up steam. But that doesn't mean there aren't plenty of people who will take advantage, Nagler says.

"Coming to the physician office under the best of circumstances is time consuming," he says. "Many ailments people might have don't require that time commitment. This is easier and less expensive and it works within a media that is become so familiar to so many people."

Here are the details:

For a $30 annual membership fee, and a flat $38 charge for any one physician consultation, patients can connect with physicians pretty much immediately either by phone or video.

It's all run by partner Teladoc, which, Nagler says, has an excellent track record in developing and implementing telehealth services for health insurers and employers. It currently covers more than four million beneficiaries and employees in the U.S. Depending on when they need care, patients using the service may not always get a Continuum physician, but those physicians have first right of refusal. If no Continuum physicians are available, the call will roll to a physician in Teladoc's national database.

Nagler's not worried the service will siphon patients from physicians at Continuum.

"This specifically precludes a patient from developing a relationship through Teladoc," he says. "You get assigned to whoever is in the queue, so this is not a surrogate for routine primary care, but is a way of expanding primary care by removing some of the barriers."

But with a service like this, obviously some barriers have to be put into place. For instance, the "tele-docs" will not be able to prescribe narcotics, and patients, as previously mentioned, do not have a choice of practitioners.

"This is not primary care, it's just an add-on," Nagler says, adding, without being specific, that patients identified as using the system too often will be "curtailed from doing that."

On the surface, I'll admit, it may not seem like a big, innovative step, and maybe it's not. But it does open up new revenue streams and new sources for patient interactions for the physicians that call Continuum home in some way.

It's a way to expand office hours without a physician revolt, and it keeps patients in the hospital's ecosystem. Perhaps it will bring more patients who don't have a primary care physician into Continuum's sphere. It does cater to some degree to concierge crowd, who don't want to wait, and best of all, it's an all-cash or credit business. No waiting around for reimbursements and patient billing.

"We're going to measure the volume of calls and activity and the economics and referrals that come into our system as well as satisfaction rates," says Nagler, who adds that at some point, Continuum docs may be available to patients in an expanded geographical area, that is, outside New York City.

"I think it has the potential to bring in a younger population initially who may not need the services of a traditional hospital environment," he says. "As we gain acceptance, it has the potential to percolate up through the family, if you will."

Not if I will. If the patients will.