On telehealth and the future of rural health care
Corey Scurlock, MD
As hospitals across the nation confront problems of staffing, rising costs, and a more acutely ill population, simply returning to the pre-pandemic ways of delivering clinical care is not possible. Faced with rising out-of-pocket costs from high-deductible health plans and buoyed by new regulations, patients are demanding consumer-friendly treatment and services. Payment is increasingly based on value as governments experiment with new models of care. With operating margins already challenged, the need to keep patients in the community for care has never been more intense.
Rural and critical access hospitals face those same challenges as well as huge service areas and a lack of specialist physicians. The majority of rural care providers know that technology is a big part of the answer to today’s challenges – especially low-cost, high-return solutions that can be implemented quickly and without friction.
Perhaps the biggest piece of the puzzle is telehealth. Rural hospitals have for years contracted with academic medical centers for remote episodic help with patients with clinically complex conditions. The recent loss of physicians and nurses to the Great Resignation has complicated matters, as urban hospitals struggle to staff their own departments and remain in pandemic mode.
If the goal is to ensure patients are able to stay in the community, a new, more mature model of telehealth must emerge. Rural hospitals need expert care across departments accessed at key moments on a patient’s journey to prevent unnecessary delays in transitions so people get the right care at the right time in the right setting.
Virtual care can start in what is now the front door of a hospital – the emergency room – all the way to delivering discharge instructions. At each step, virtual caregivers can utilize the electronic health record, saving valuable time for bedside patient care. Rural and critical access hospitals often have to park patients in the hallway as they triage and wait for an open bed. As a wealth of clinical evidence shows, ER patients with delayed care have poorer outcomes. A remote intensivist steeped in critical care medicine can track the vital signs of patients and do intake more quickly after patient arrival, often guiding inexperienced staff through a test, diagnosis, and procedure.
An important use of virtual care is in appropriate patient transfers. Many patients are sent to intensive care who don’t need to be. Some can be easily treated in the ER and sent home. Others may need a complex operation, for which a transfer to a level 1 trauma center is needed.
There are a lot of telehealth solutions vendors, but a successful program must fit a hospital’s unique needs. Questions to ask include:
Telehealth is not meant to replace in-person staff. Rather, it is about augmenting current capacity, allowing for the continuation of clinical service lines that might otherwise have to be jettisoned for lack of qualified staff.
- Are the vendor’s physicians licensed to practice medicine in your state? If not they cannot order tests, prescribe medications, or do anything but recommend a course of action.
- Are the virtual caregivers dedicated to your facility (and a few others)? They should be enabled to establish relationships with staff physicians and nurses and be able to seamlessly access the electronic patient record.
- Does the vendor have specialists in every area? For example, many vendors lack psychiatrists, who are in short supply nationally amid an unprecedented rise in mental illness. Psych consults often occur shortly after a patient presents in the ER.
- Does the vendor know about patient flow optimization techniques that support optimized bed utilization?
The need for financial stability must be met by solutions that focus on efficiency, productivity, and cost savings so communities can keep what is often the largest source of income as well as an invaluable resource to keep people healthy.
Corey Scurlock is the founder and CEO of Equum Medical, a telehealth company based in New York that was recently selected as an NRHA Pipeline Partner. Equum’s services span the acute care continuum but are configured to meet the needs of its rural and critical access hospital clients.
Kusum S, Mathews, KS, Durst, M, et al. Effect of Emergency Department and Intensive Care Unit occupancy on admission decisions and outcomes for critically ill patients. Crit Care Med. 2018 May 46(5): 720–727
Bernstein, SL, Aronsky, D, et al. (2009) The Effect of Emergency Department Crowding on Clinically Oriented Outcomes. Acad Emer Med. (16):1-10