Using Telemedicine to Keep Care Local

With virtual care facing a crossroads, rural hospitals and health systems are touting the platform as a means of reducing transfers and keeping patients closer to home and family.

Rural healthcare providers are struggling to stay open. They don’t have the resources to treat a variety of patients on site, and they end up transferring them to larger hospitals who have specialists on hand.

Hello, telemedicine.

Often thought of primarily as a platform to connect patients with doctors for a virtual visit, telemedicine also has the potential to bring needed specialists to smaller hospitals and health systems for consults and even treatment, enabling those smaller providers to keep their patients and reduce costly and risky transports. The strategy also gives large health systems an opportunity to become a telemedicine hub, offering their specialists to other hospitals who sign on as spokes.

This strategy could be a crucial lifeline for hospitals and health systems across the country, not to mention the virtual care industry. And it comes as several pandemic-era waivers that allow providers more leeway to use telemedicine are set to expire at the end of September, unless Congress takes action.

UnityPoint Health saw an opportunity in 2017 when it partnered with Access TeleCare to launch a teleneurology platform in three rural hospitals, offering telestroke, telehospitalist and remote EEG interpretations. The platform also offers virtual behavioral health services, virtual consults in the ED and consultation-liaison psychiatry services in ICUs and med-surge units. UnityPoint has since expanded the network to eight hospitals across two markets in the 18-hospital health system, which spans Iowa, Illinois and Wisconsin.

Health system executives say the platform not only expands care to patients with access challenges, but also helps insulate hospitals against the influx of disruptors aiming to siphon care away from traditional providers. They’re betting on the understanding that people prefer their care from a known healthcare entity rather than someone new to the industry.

“I think one of the things we've observed by these disruptors … is that healthcare is a very complex industry,” says Stephanie Johnson, MHA, UnityPoint Health’s executive director of system virtual care. “It's not one that is easy to just jump into, and healthcare is still deeply personal for consumers.”

With telemedicine, she says, healthcare leaders can create a network that bolsters smaller and rural healthcare sites, giving them access to more services that will improve patient engagement and loyalty.

“What we're seeing is that it's not necessarily a turf war for acquisition of patients, but really just appreciating and embracing the need for technology in order for our patients to have easier access to the care that they need and are probably already in some way accessing our system,” she adds.

“You can order anything on Amazon, but is really right for healthcare?” asks Cate Ranheim, MD, a hospital medicine specialist with UnityPoint Health “Those apps don’t work in healthcare.”

Keeping Healthcare Local

At Palo Pinto General Hospital, an 81-bed Level IV Trauma Center in Texas, officials wanted to reduce costly and complicated transfers and keep more of their patients. The point was driven home, says George Thomas, MD, an internal medicine doctor and hospitalist, during the COVID-19 pandemic.

“Every room in the ICU was completely occupied with intubated patients, which was very rare for us,” he says. “Usually we would hardly even have one. … We were using wings of the hospital that we hadn’t used in decades.”

While the pandemic eventually eased up, the need to improve didn’t. Hospital leaders wanted to treat more of these critical care patients rather than shipping them off to Fort Worth or another distant location at least 90 minutes distant.

They invested in a telemedicine platform that allows Palo Pinto to access remote pulmonology and critical care specialists, a move that helped the rural hospital reduce emergency department transfers by roughly 36% a year and pulmonology transfers by more than 40%. That affected about 200 patients annually.

The impact, Thomas says, has been “life altering.” Before this, he says, hospitalists were spending all their time waiting for transfers and working just to keep patients ready for the trip to another hospital – and they were getting perhaps four days off a month. Now, he says, they’re treating patients, keeping them closer to home, and feeling better about what they do.

 “I can actually sleep at night without having to be on call,” he says.

The process wasn’t without its challenges. Palo Pinto had contracted with a telemedicine company earlier on for access to a pulmonologist, but that service was only available Monday to Friday, from 8 a.m. to 5 p.m. The remote providers often clashed with Palo Pinto staff over orders, note dictation, even coming online when requested.

“That was actually a horrible experience,” Thomas says. “It was dangerous.”

The hospital ended that relationship quickly and, following the pandemic, moved forward with a new provider offering round-the-clock service. They made sure to establish all the necessary parameters ahead of time as well.

Palo Pinto is now looking to expand that platform to bring in other specialists. For example, noting that they transferred 90 patients last year for kidney care issues, they’re using the platform to connect with a nephrologist. They’d also like to connect with endocrinologists, and specialists to help with speech, swallowing issues, even medication management.

“Hopefully we can try to retain some of those patients, keep these patients closer to the community, keep them closer to their families and try to help them through that difficult time and then get them home,” Thomas says.

A Sacred Calling

That’s the same philosophy at UnityPoint. Johnson says patients should be able to get the care they need at a location as close to their homes, families and communities as possible.

“As a physician, I feel like this is a sacred calling and the sacred mission that we have to keep people healthy and in their homes and living good lives,” Johnson says. “And apps aren’t how you do that.”

For large hospitals and health systems, that virtual care strategy helps not only in improved patient satisfaction and clinical outcomes (by reducing transports), but in reducing stress on inpatient services and giving specialists an opportunity to help patients beyond who they can see in person.

It also creates better relationships between patients and their care teams.

“Often the strongest relationship that a person in the community has is with a nurse at their local clinic,” Johnson adds. “It’s a fallacy to think it’s always just a doctor and a patient. It’s much more complicated than that, and in a good way. It’s a whole team of people. Or it should be. That’s the best practice.”

“We as healthcare providers recognize what our communities and what our patients need,” adds Ranheim. “It’s really about the relationships.”

And of course, it’s also about the finances. In rural hospitals, leadership needs to balance the cost of telemedicine with the ROI in patient care. Will this access bring back enough patients to improve the bottom line? How many new lines of service can be supported by a virtual care platform, and can the hospital support those services? A virtual specialist might sound like a great idea, but if there aren’t enough patients requiring those services, the cost could be prohibitive.

For larger health systems and hospitals, the challenges lie in balancing workflows for specialists and creating a business plan that will entice spoke hospitals while not pricing them out. What are the responsibilities and commitments of a hub health system? How much of a specialist’s – and a hospital’s - time can be spent online without affecting in-person care or resources?

“The key to the growth here is making sure that there's this level of education and awareness that's built into provider workflows, so that it's very easy to decide for which patients make sense and also making those services readily available,” Johnson points out.