By Dr. Alan Roga, President, Provider Market, Teladoc
Telehealth is more than a method for delivering care. It is a tool for achieving innovation and executing strategy. Even as classic uses of telehealth continue to grow, hospitals and health systems are applying it in innovative new ways to support their clinical and financial goals. The use cases range from extending care to new markets and patient populations, to improving staff and resident training, to meeting new Joint Commission requirements, to helping prevent readmissions, and even for providing remote medical care for disaster relief.
The Centers for Medicare & Medicaid Services now covers 40 telehealth services, and the 21st Century Cures Act that Congress passed in December 2016 directs the agency to find more.[i] Some hospitals and health systems are already ahead of the curve. Here are some interesting and effective ways telehealth is being used today that other hospitals could emulate.
1. Improve Internal Finances
Telehealth services are commonly included in wellness programs, but many hospitals are achieving substantial savings by making telehealth a more integral component of their benefits program. Hospital employees, like employees of other organizations, frequently visit the emergency department for treatment because the ED is convenient, although not required for the type of care needed. Such employee visits cost one hospital $1.3 million in one year. The hospital changed its benefit structure to discourage nonessential ED visits. It reduced the copay for ED visits to $0, but only if the employee underwent a telehealth consultation first. Telehealth utilization immediately increased and prevented many nonessential ED visits, which reduced pressure on the ED and saved the hospital more than $900,000 in treatment costs.
Another hospital that serves a large indigent patient population created a telehealth program to reduce unnecessary use of the ED and the associated uncompensated care. The hospital studied the population and learned that more than 60 percent had access to a smartphone. It began promoting telehealth treatment by phone, and also established telehealth accounts for those patients right in the emergency department. The program produced $500,000 in savings in its first six months.
2. Enhance Resident Education and Staff Training
Some academic hospitals are using telehealth systems to enhance their resident training. Physicians can take advantage of multi-party video conferencing to enable residents to observe and discuss procedures or patient consultations if the resident is not physically present. Conversely, residents can use video conferencing to request consultations.
The same principles can be applied to meet many training and collaboration needs. One health system is forming its multidisciplinary team to meet The Joint Commission’s new Antimicrobial Stewardship Standard by using multi-party video conferencing to link providers at different facilities. The standard[ii] specifically notes: “Telehealth staff are acceptable as members of the antimicrobial stewardship multidisciplinary team.”
Project ECHO uses telehealth principles to conduct virtual clinics where medical specialists provide training to community providers. The project has expanded to include 112 partners in the U.S. and 20 other countries.
3. Increase Revenue and Market Share
Telehealth is a proven and cost-effective way for hospitals to expand their services to new patient populations and to new geographic areas. Telehealth is especially effective for leveraging specialists across a health system where skills shortages make it difficult to have specialists at each facility. Emerging, high-growth practice areas include dermatology and behavioral health. With telehealth, hospitals and health systems can also advance into competitors’ traditional geographic territories without undertaking the expense of building or leasing facilities.
Hospitals can also create new revenue streams by using telehealth to create new services. Some hospitals have contracted with assisted living facilities to provide medical services via telehealth. Such arrangements give the hospital access to new patient populations, and save patients and assisted living facilities the inconvenience and expense of arranging transportation for routine care.
Telehealth can also form the foundation of wellness programs to be marketed to area employers. Some providers are lending an innovative twist to that concept by offering telehealth services to local school boards where budget or nursing shortages prevent staffing each school with a nurse.
Although it is not a revenue-driven program, the American Red Cross provides an extreme and interesting example of how telehealth can help overcome geographic and infrastructure barriers to providing care. The organization is currently conducting a pilot to use telehealth to quickly provide remote medical services to areas affected by disaster.
4. Improve the Discharge Process and Help Prevent Readmissions
One program is simultaneously helping a hospital prevent readmissions and streamline the discharge process. Patients are encouraged to schedule their families or caregivers to have a telehealth consultation before the patient leaves the hospital. The program allows family members to sit in during rounds, ask questions of doctors, nurses, therapists and other providers, and receive after-care instructions — all without having to come to the hospital. Improved patient and family engagement can lead to improved adherence to after-care instructions, and in turn, reduced readmissions.
The programs and possibilities described above are well outside what many people think of telehealth. They also underscore that telehealth can be very flexible. Hospitals and health systems can tailor telehealth programs to support their specific strategic objectives. By opening your mind about what telehealth can do, you can open your organization to many possible innovations to improve care delivery, staff development, care coordination, partnerships and financial performance.
[i] The Act is available at https://www.congress.gov/bill/114th-congress/house-bill/6/text.
[ii] The Joint Commission Antimicrobial Stewardship Standard. Approved July 19, 2016. Accessed February 3, 2017 from https://www.jointcommission.org/assets/1/6/New_Antimicrobial_Stewardship_Standard.pdf.