Hospitals today are seeing an increase in both patients and higher-acuity cases that require more complex care. Each year, more than 139.8 million Americans visit an emergency room, and more than 13 million visit the ED for mental health. The cost of those visits adds up to more than $80.3 billion.
These statistics highlight a need for hospitals and health systems to have high-level strategies that aim to: serve a growing number of patients; deliver consistent, quality care across a range of healthcare needs (low and high acuity); provide timely acute behavioral health services; and achieve a level of predictability needed to keep the doors open and deliver care to everyone who needs it.
For many hospitals and health systems, virtual care is playing a bigger role in those strategies due to its ability to lower overall costs; deliver consistent, quality patient care; expand specialty care; and enhance the brand.
Every strategy starts with data
As hospital and health system executives look to get a clearer picture of the unique needs of their organizations, transfer data plays a critical role. Understanding which types of – and how many – patients a hospital transfers out over the course of a year can identify the number of transfers that could have been prevented if a specialty, for example, neurology, was available. From there, the team can connect transfer data to revenue. For example, how much revenue was lost due to those [neurology-related] transfers? These numbers can identify whether implementing a virtual care program would be financially beneficial.
Beyond transfers, teams should look at and measure the patient experience, timeliness of care and average ED boarding time, particularly for behavioral health (BH) patients. Begin to ask and discuss:
- If we could assess and disposition a BH patient in two hours or less consistently, how would that drive down costs? Specifically, nursing and ED provider resources.
- Is the ED boarding of BH patients connected to beds being full in the inpatient unit?
In the latter case, quicker dispositioning in the ED is not going to help; rather, the team will need to focus on how to most effectively manage the acute BH issue and quickly to reduce length of stay (LOS) and discharge patients safely to free up ED resources.
For other specialties, such as infectious disease, quantifying the LOS is important, but there are several other factors. The hospital needs to understand what their typical case load of infectious disease patients is and extrapolate how many patients they could retain if they had access to a virtual infectious disease specialist. Also, monitoring antimicrobial utilization costs and seeing if there is a potential to lower those costs through an antimicrobial stewardship program – e.g., having an expert weigh in on what is the most appropriate (narrow spectrum) antibiotic to use for a particular infection or when to transition IV antibiotics to oral – can dramatically reduce costs and accelerate the transition to outpatient therapy, thereby helping patients heal more quickly with appropriate medication.
Having the aforementioned data helps teams make more informed decisions. With the right information, a team can develop a model that works in their unique setting and establish a system to collect analytics in order to demonstrate the model is achieving the necessary outcomes.
With the right metrics in place, virtual models deliver predictable, quality care
As a model of care, virtual is uniquely designed to deliver timely and consistent patient care. Compared to in-person care where there might be coverage gaps, expensive full-time staff, the use of high-cost locum tenens physicians, and environments that foster burnout, virtual care efficiently and cost-effectively addresses the realities on the ground.
In one instance, a behavioral health hospital launched a fully virtual BH telemedicine program that saved it from closure following the resignation of the facility’s psychiatric medical director. Without the virtual solution, the rural hospital would have had to find an in-person replacement for the director, a significant hurdle facing many hospitals in remote areas of the country today. With this program, a solution was up and running in just 90 days. Another example of virtual care’s ability to help hospital partners and patients succeed is a multi-specialty program that reduced patient transfers and increased the case mix index for a rural community in Texas. Patients are thrilled with the service because it allows them to receive care close to home, family, friends, and support services.
Virtual care, whether it’s a hybrid or virtual-first model, helps address the significant provider shortage facing hospitals and health systems today. For many rural and underserved populations in America, a virtual provider is the only access they have to critical specialty care in their community. While virtual care models have made a measurable impact on rural hospitals, it is driving significant results for urban hospitals as well, given the capacity, timeliness, and quality enhancements virtual care is uniquely designed to deliver.
A successful program includes stakeholder participation, seamless execution and a smooth transition for providers
Successful programs have executive buy-in from the CEO, chief medical officer and, oftentimes, CFO/finance. Virtual care is a clinical service that represents a fundamental shift in the way that care is being provided – from bedside to screen. As a result, there needs to be clear agreement and alignment across the organization and its virtual partners.
When it comes to seamless execution and long-term success of a virtual program, the following are important:
- Buy-in across the entire team: administrative staff, providers, and executives
- Integration with the onsite team and customization of the solution to fit within their existing, well-established workflows
- Virtual care delivery that is intentionally empathetic to the patient and creates a positive patient experience – breaking through the screen to deliver excellent care
- Ability to document and perform order entry within the client’s existing EMR
- Alignment on key metrics/outcomes to track effectiveness of the program
As we continue to face challenges that impact the quality of care we’re able to deliver (and patients receive), we need to consider new models that address those challenges consistently across acute healthcare settings. With the right data, models and metrics, stakeholders, and strategy, virtual care is delivering consistent value for both the business and patients, making it a trusted – and proven – solution to many of our system’s complex problems.
Chris Gallagher
Chris Gallagher, MD is CEO of Access TeleCare.
