The Importance of Pilot Programs: How Critical Access Hospitals Can Use Telehospitalists

Our company has spent years providing Telepsychiatry services to acute-care hospitals with significant patient needs in each facility’s Emergency Department (ED).  Over time, we have also begun seeing similar needs for Telehospitalists at hospitals of all sizes. 

While patient volume and needs vary widely, Telepsychiatrists provide coverage for the ED and for the Medical Floor, and each setting functions almost identically for hospitals of all sizes. 

In contrast, Telehospitalists are needed across all areas of a hospital, but the needs are unique based on hospital size.  This requires a hospital-wide point of view to use Telehospitalists in the best and most meaningful ways.

So, let’s look at the following with regards to Telehospitalists:

  • What Telehospitalists can do,
  • How to get started,
  • Current challenges,
  • Benefits and return on investment.

What Can Telehospitalists Do?

Telehospitalists work both days and nights and provide nearly every type of clinical care as an on-site Hospitalist.  The difference lies in the care being performed virtually, through encrypted real-time audio/video connections. 

With proper access to a hospital’s Electronic Medical Record (EMR) system, Telehospitalists can effectively document their patient encounters in the EMR, admit new patients, discharge patients, transfer patients, and participate in the co-management of patient care with specialty areas.

Admissions take place virtually by coordinating the patient assessment with an onsite clinician – usually an Advanced Practice Provider (APP) or a Registered Nurse (RN).   The onsite clinician assists in securing a full patient history along with any needed examinations.  By using innovative devices such as a digital stethoscope, Telehospitalists can personally evaluate a patient and deliver a full diagnosis and treatment plan.

Telehospitalists also provide overnight call coverage for the nursing staff.  This allows the clinical staff to receive assistance after hours from a licensed, board-certified physician.  This is particularly helpful in solving clinical issues or offering guidance on questions that may surface.

How to Get Started

One reliable way to begin using Telehospitalists is to do so with a pilot program. This allows a hospital to seamlessly integrate telehealth into its clinical and operational workflows.

A pilot program lets facilities learn how to walk before they run while still working through the possible newness of how to best use a virtual physician. A pilot program offers clinical services tailored to the size of the hospital, which is why implementing a Telehospitalist program works well in critical access hospitals.

These facilities are small by definition, with no more than 25 beds, but they also have very real needs for support in their Hospital Medicine programs. While a critical access hospital may have one staff Hospitalist on site during a weekday, there are gaps on nights and around the clock on weekends. This is an instance where a Telehospitalist can easily cover vacant shifts, such as night shifts from 7pm to 7am. By using Telehospitalists, even the smallest of hospitals can make use of a dedicated, board-certified physician to cover night shifts, even up to 365 days per year.

This pilot program approach helps critical access hospitals, and in fact hospitals of any size, to save significantly on spending while still having access to Telehospitalists whenever needed. These programs also allow even the smallest of hospitals to benefit from telehealth solutions.

Current Challenges

The unique challenges before critical access hospitals include access to physicians. Physician recruitment and subsequent retention of board-certified physicians typically tops the list of needs. These challenges are usually met with solutions that include:

  • Costly usage of locum tenens physicians or practice management groups (inflated shift rates, and large expenses for travel, lodging, and malpractice)
  • Inconsistent shift scheduling with local Primary Care or ED physicians
  • Full payment for night shifts with low volume or admissions
  • Lack of coverage that results in poor throughput or patient transfers

Benefits and Return on Investment

One of the most significant benefits in using Telehospitalists is the ability for a hospital to have around the clock access to specialized experts in Internal Medicine. By using Telehospitalists, hospitals receive help with admissions and discharges, increase patient and staff satisfaction, and give daytime physicians their nights back.

This investment reaps immediate returns. Physician recruitment and retention increases promptly, particularly when on call duties are rare or not required. Also, a Telehospitalist on average will offer a hospital 25% to 30% savings on nightly physician costs. These direct savings can positively impact the facility’s profitability and allow for further adoption of other telemedicine service lines.