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Weighing Telehealth's Pros and Cons

 |  By Lena J. Weiner  
   August 04, 2014

Remote teams can cut hospital costs and help fill staffing gaps, but HIT and regulatory requirements can be daunting, especially for small, remote hospitals.


Bryan Coffey
CEO of Hamilton County Hospital

A human-size robot roams the halls of Hamilton County Hospital. Through cameras and a tablet mounted at eye level, doctors working as far away as California, New York, or Massachusetts view and treat patients in this rural Kansas hospital remotely.

Hamilton County Hospital is a 25-bed critical access care hospital in Syracuse, a small town of just over 1,800 people on the southwestern Kansas frontier. "The nearest Walmart is 55 miles away," says Bryan Coffey, the hospital's CEO. While it's typically difficult to recruit staff to work in such remote care settings, Coffey has found a technology-based strategy for both keeping the hospital fully staffed and cutting costs.

"We're the perfect model for telehealth and remote teams," says Coffey.

"I have a passion for two things: rural healthcare and telemedicine," he continues. Delivery of care in Coffey's part of Kansas is not always easy. "This is a region where people have to drive eight hours one way to see a pediatric specialist." Recognizing that his patients would be better served by access to more specialists than Hamilton County could realistically attract or support, Coffey found a that telemedicine is the right answer to his hospital's staffing challenges.

The robot, identical to robots used for healthcare by the Department of Defense cost $2,300 a month to rent. "But, if we keep even one patient [at this hospital], it pays for several months of the robot," Coffey says. Not only can rural hospitals take advantage of talent from outside the immediate area, hospitals in areas where labor is expensive can take advantage of less expensive labor pools in other areas, says Bruce Carothers, vice president of Telehealth Solutions at AMN Healthcare, a healthcare recruiting firm. "You can definitely cut costs by employing specialists part time and remotely," he says.

Besides dealing with regional labor issues, there are many other benefits to implementing a telehealth program.

Convenience
Cost-saving is just one benefit of telehealth.

"It's much more efficient," says Carothers. Telemedicine allows doctors to quickly log out of an appointment with one patient and into another in seconds. "If they're prescribing an antibiotic, they can finish the video consult in 15 minutes, then move on to the next," added Carothers. "Many physicians toward the end of their careers chose this as a way to start winding down."

Aside from clinicians, other roles that lend themselves to remote teams include customer service, radiology, triage, billing, coding, and "Anything that doesn't involve having to touch or manipulate the patient," says Carothers.

The flexibility afforded by telehealth technologies allows workers who cannot commute due to health issues, child or eldercare responsibilities or lack of access to transportation a chance to work.

Radiologists Available at Any Hour
"There's a whole sector of teleradiology called 'nighthawking,'" explains Carothers. "They find US- licensed physicians who live oversees who can look at images on weekends and at night." It's one way to ensure all radiology results are in by Monday morning.

Some organizations, especially in remote areas, also employ a team of remote telepharmacists who can review prescriptions after hours. Because the pharmacists are employed by an outside service and shared by multiple hospitals, they are a less expensive option, and provide just the right amount of coverage for weekends and evenings.

But there are some challenges to be mindful of when considering remote staffing.

Remote Possibilities
As attractive as telehealth can be, the barriers to adoption are many. For starters, a hospital must have robust and reliable high-speed broadband connectivity to support clinical functions.

Another vital requirement: Physicians must be properly licensed to practice in remote locations. Since licensure is regulated by the states, this can be very complicated.

As for reimbursement, traditionally, Medicare and insurance companies have only covered telemedicine appointments when the patient was in a very remote area like Hamilton County. "This is improving every year," says Carothers. "Currently, 20 states mandate that commercial payers pay for telehealth services. But this has… been a downside."

Coffey concedes there are certain jobs around the hospital that still require in-house staffing. "Housekeeping and maintenance… Phlebotomists, bedside RNs, that need to touch the patient or change bedding and wound care all have to be done on-site," he says.

And that brings to mind an additional obstacle: bridging the gap between both doctor and patient. While the goal is seamless delivery of care, sometimes, the distance becomes noticeable. "It's critical to establish a relationship prior to telemedicine," says Carothers.

He cautions that it's important to properly collaborate with and manage a remote team as well. "There's always a little bit of a gap when doing things remotely relative to a face-to-face conversation. It isn't always easy." He suggests putting in extra effort to fill the void with phone calls, instant messages, and video call services such as Skype and Facetime.

Coffey insists, however, that Hamilton County's patients hardly notice the distance once they spend a few minutes with a remote doctor evaluating them via the robot. "You would be shocked how many people extend a hand and say 'thank you, doc,' only to remember there's no hand to shake on the robot."

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Lena J. Weiner is an associate editor at HealthLeaders Media.

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