September 24, 2020
Telemedicine is becoming more and more common for patients who prefer to remain at home for non-emergent issues. Increasingly more providers are offering telemedicine services to meet this need and increase their own capacity. With COVID-19 forcing people to stay home as much as possible, telemedicine has come front and center for hospital settings as well, leveraging the many benefits of inpatient telemedicine.
The Telemedicine and eConsults for Hospitalized Patients During COVID-19 study, recently published by PMC, notes that thanks to changes in private insurer and Medicare and Medicaid Services policies, most patients can now utilize telemedicine from any location, home and hospital included. “Many of these regulatory changes are directly applicable to physician consultation in both the ED and inpatient settings,” the authors say. “Video visits can be used to evaluate patients without a procedural need or for conditions where physical exam is not a major contributor to clinical decision making.”
Inpatient telemedicine technology can also extend to eConsults, where a hospital physician can easily connect with other physicians or healthcare professionals outside of the hospital or on other floors for patient diagnosis or treatment assistance, as well as for gaining more information about the patient’s history or condition. Traditionally, physician consultations take place without the consulting physician ever evaluating the patient in person or over the telephone. Instead, the consulting physician speaks with the attending physician and reads a written report before making any recommendations. With inpatient telemedicine, however, consulting physicians have the opportunity to also personally speak with and evaluate the patient virtually for any additional information they may need. They can gain a greater understanding of the case and speed up recommendations and patient care through collaboration with the attending physician.
An interesting and relevant use case right now is COVID-19. Hospitals are having to think outside of the box to deliver care to COVID-19 patients and non-COVID-19 patients at the same time. The report mentioned above highlights a specific scenario where inpatient telemedicine could make a significant difference in how more remote hospitals or hospitals with capacity issues can still care for patients.
“Importantly, the use of remote ED and inpatient consultation could harness a centralized team of providers that could manage remote consultations across multiple hospitals. This may become particularly important at institutions experiencing a surge of COVID-19 patients where specialists are being redeployed to provide care in intensive care units, EDs, and inpatient wards. As fewer specialists are available to serve as consultants for their trained specialty, more facilities will likely need to be serviced by a smaller team of specialist providers.”
Inpatient telemedicine is giving hospitals a new method to reach more patients, extend their staff, leverage the expertise of outside providers, and have greater flexibility into how they deliver patient care.
While the benefits listed above are reason enough to invest in inpatient telemedicine technology, there are many additional benefits that hospitals across the United States are already realizing. Combined with a thoughtful telemedicine protocol, hospitals can see a significant improvement and enhancement in how they serve their communities.
Inpatient telemedicine is extending the services of remote hospitals that often lack the specialty physicians that larger hospitals in bigger cities can offer. Remote hospitals, clinics and ERs can leverage the expertise of physicians and providers at other hospitals to help diagnose patients and recommend treatment protocols. Providing equal care to all patients, no matter where they live or work, is critical in ensuring all populations receive adequate care with the best outcomes.
Telemedicine in the hospital setting not only enables remote hospitals or hospitals with stretched resources to care for patients, but it also allows specialists to extend their reach to more patients so hospitals can increase their patient load with greater confidence. This is evident in the COVID-19 use case above but also with hospitals that see any kind of sudden increase in patient admissions. Instead of turning patients away to other hospitals, thereby risking patient health, hospitals can often admit more patients knowing they can assign some existing or new patients to telemedicine interactions instead based on need. Flexibility to triage patients based on how they present and the urgency of their case is a highly-valuable asset to any hospital.
There is another, less discussed benefit of inpatient telemedicine. Physicians and specialists can spend an incredible amount of time commuting from their clinics, offices or other hospitals to another hospital — time not being spent caring for patients. Inpatient telemedicine allows providers and specialists outside of the hospital to reduce how frequently they commute in many cases. The truth is, not all patients need in-person physician visits for every appointment. Because specialists and providers are able to conduct remote examinations and/or consult with attending physicians remotely via telemedicine, they can see more patients with less wasted time and effort.
On the other hand, not all patients have the luxury of having the specialist or provider come to them from another location. In these cases, the patient has to be moved to wherever the specialist or provider is. Inpatient telemedicine benefits the patient in these cases, often eliminating the need for costly hospital transfers altogether.
With providers and specialists available around the clock via telemedicine, patients are more likely to receive care faster, improving outcomes and patient satisfaction. Telemedicine is even capable of connecting patients to physicians, specialists and other providers around the world.
Patients can wait hours to full days to see a specialist, simply because the physician is in another location. With telemedicine, however, providers can shorten response times by conducting many appointments virtually, even directing attending physicians on the proper diagnosis or treatment protocol that they can begin immediately until the specialist arrives.
ERs experience benefits in response times as well, often saving the lives of critical patients who need rapid intervention. Derek Morrison, assistant administrator at Bryan W. Whitfield Memorial Hospital says, “It’s 1:00 a.m. in the rural South. A patient with stroke symptoms arrives in our ED. Prior to implementing telemedicine and telestroke protocols, these patients would have delays in diagnosis and treatment of up to three of four hours. We now have a diagnosis and treatment plan in less than 45 minutes.”
The patient journey can be long and complex, involving multiple nurses, physicians and specialists over several days and months. It involves more than just diagnosis and treatment but post-care, including medication management, follow-up appointments and recurrent or related issues that require readmission.
With inpatient telemedicine, all medical experts can more easily collaborate care on each step on the patient’s road to recovery, even if they aren’t physically present. This ensures patients receive the right level of care and attention during each stage of their journey, even after being discharged from the hospital.
Telemedicine appointments can continue once the patient returns home, helping physicians, physical therapists, pain management experts, mental health professionals and other providers to continue checking in on and caring for the patient until they are fully recovered — all without requiring the patient to travel to and from office appointments in many cases. Because patients remain in the care of the hospital and its providers over the long haul, they are more likely to adhere to their treatment plans, take their prescribed medications, and follow doctors’ orders. This results in fewer recurrences and hospital readmissions and better patient outcomes.
Hospitals that provide inpatient telemedicine care to patients often report a reduction in operating costs, even after the front-end costs are considered. In a report, Economic Evaluation of Telemedicine for Patients in ICUs, published by ResearchGate, researchers found telemedicine used in the ICU was “cost-effective in most cases and cost saving in some cases.” These cost efficiencies and cost savings come by way of patients typically having to stay in the hospital for less time because of greater access to care via telemedicine. The less time a patient remains in the hospital, the lower the maintenance and clinical and physician staffing costs are. The study found a savings of $155 to $193 per patient when tele-ICU services were provided.
The Permanente Journal reported similar findings in A Business Case for Tele-Intensive Care Units published report, saying, “Implementation of a tele-ICU system was associated with cost savings, shorter lengths of stay, and decreased mortality.” And while initial investment into an inpatient telemedicine system increases costs, it “eventually results in cost savings and better clinical outcomes.”
Hospitals should perform a cost-benefit analysis when considering investment into an inpatient telemedicine solution. While the upfront capital cost may need to be budgeted for, the operational efficiencies and potential to increase revenue over time can offset those costs. In addition, telemedicine capacity is becoming less of a nice-to-have and more of a requirement to meet patient and physician demand. Hospitals that embrace telemedicine and use best practices to lay the proper telehealth foundation will attract more patients and skilled providers, giving them a greater ability to provide excellent, modern healthcare to a wider range of patients.
COVID-19 has changed virtually everything about how we live and work. Healthcare is no different. People still get sick. They are still injured. Payers understand that in many cases, patients cannot wait to be seen and the hospital is their only option. They do not want a lack of insurance coverage to stop them from seeking care in a hospital and have adjusted how they cover telemedicine appointments.
Because Medicaid, Medicare, and private insurers have waived their original requirements for telehealth services to occur only in a patient’s home, hospitals can receive full reimbursement from payers. This dramatically increases the number, amount, and speed of reimbursements hospitals receive for their services. Further, when hospitals can provide a full continuum of care for patients without the patient having to go outside of the hospital provider network, the hospital is able to retain that revenue while streamlining patient care.
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is what the Centers for Medicare & Medicaid Services (CMS) says is “the first national, standardized, publicly reported survey of patients’ perspectives of hospital care.” The survey is required by CMS for all U.S. hospitals to increase transparency of the quality of care provided by hospitals to justify the public investment.
HCAHPS is just one measure of a patient’s experience throughout their hospital stay, but it is a good indicator of how well a hospital is meeting its patient satisfaction goals. Those scores matter as they can dictate how much Medicare reimbursement is given. The scores are also publicly reported on the Hospital Compare website, giving patients a way to compare hospitals when they have the choice to elect where they have procedures or receive care.
Because inpatient telemedicine enables hospitals to respond faster to patients with the appropriate providers throughout their healthcare journey, patients are generally happier with their experience. As noted previously, they spend less time in the hospital and have lower mortality rates. There is evidence of fewer follow-up visits, lower readmissions and better overall outcomes as well. All of these lead to higher HCAHPS scores and a better hospital reputation.
The American Hospital Association says, “By increasing access to physicians and specialists, telehealth can help ensure patients receive the right care, at the right place, at the right time.” This is the goal of every hospital and the desire of every patient. With inpatient telemedicine technology in place, hospitals can extend and enhance the quality of care they provide to patients with greater flexibility.
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